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DARWIN SQUASH ASSOCIATION

PENNANT COMPETITION  NOMINATION  FORM   SEASON  1  –  2013  

     (Commences  Tuesday  12th  February  –  Grand  Final  Tuesday  4th  June)     NOMINATIONS  CLOSE  –  COB  SATURDAY  9th  FEBRUARY    

NOTE:  To  be  eligible  to  play  Pennant  you  MUST  be  a  financial  member  of  the  Darwin   Squash  Centre.    DSC  Membership  includes  membership  to  the  Darwin  Squash   Association  and  National  Player  Insurance.    Forms  are  available  from  the  Centre  Staff.    

Please print clearly all required details

PERSONAL DETAILS   SURNAME

DOB

CHRISTIAN NAME CONTACT DETAILS

/

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HOME

MOBILE WORK EMAIL

PLAYER HISTORY    

LAST CLUB   GRADE  PLAYED   MATRIX  REG.  NO  

LINE NO.   MATRIX  RANKING  

(If known)  

(If known)  

PENNANT FEES    

**To be  paid  in  full  by  12th  February  2013**  

$180.00 per  person                                                                                            PAYMENT  OPTIONS  –  Cash  or  EFTPOS  only    

DSA Pennant  Fees  are  inclusive  of  court  hire,  balls  and  Matrix  administration  fees.    

NOTE :  If  a  player  is  unable  to  pay  the  full  amount  by  the  due  date  he/she  may  chose  the   option  of  paying  the  Pennant  Fees  in  two  (2)  payments   1st  Payment     $110.00   Due  by  12th  February  2013   2nd  Payment   $    70.00   Due  by  19th  March  2013    

PLAYER AGREEMENT   I  hereby  agree  to  abide  by  the  Darwin  Squash  Association  Pennant  By-­‐Laws  as  determined  from  time   to  time  by  the  duly  elected  DSA  Committee.             Signed  :  __________________________________________________________________      Date      _____/_____/_____    

OFFICE  USE  ONLY   Amount  Paid    

Receipt No.  

$  

                             Date  Paid    

Received by  

             /                /    

Darwin Squash Association Pennant Nomination Form  

Darwin Squash Association Pennant Nomination Form

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