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2012
WORLD INDIVIDUAL CHAMPIONSHIPS
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REGISTRATION FORM (one per player) |
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To be submitted by 15 March 2012 |
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NAME: |
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POSTAL ADDRESS: |
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NATIONALITY: |
CLUB: |
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Telephone #: |
Mobile/Cell #: |
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E-mail address: |
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CHAMPIONSHIP DETAILS REQUIRED |
Cost |
Number |
Amount |
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Period |
Ancients: DBM v. 3.2 |
Senior |
R300.00 |
1 |
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Women |
R300.00 |
1 |
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Junior |
R300.00 |
1 |
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Ancients: Field of Glory |
Senior |
R300.00 |
1 |
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Women |
R300.00 |
1 |
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Junior |
R300.00 |
1 |
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Morabaraba: GAR |
Senior |
R200.00 |
1 |
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Women |
R200.00 |
1 |
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Junior |
R200.00 |
1 |
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Renaissance: DBRv.2.0 |
Senior |
R300.00 |
1 |
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Women |
R300.00 |
1 |
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Junior |
R300.00 |
1 |
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World War II: Flames of War |
Senior |
R300.00 |
1 |
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Women |
R300.00 |
1 |
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Junior |
R300.00 |
1 |
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(please state size) |
S |
M |
L |
XL |
XXL |
XXXL |
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Free polo shirt |
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N/A |
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Additional shirt |
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R120.00 |
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Additional shirt |
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R120.00 |
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Golf cap (black with logo) |
R60.00 |
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TOTAL |
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In regard to the 2012 WORLD INDIVIDUAL CHAMPIONSHIPS, I undertake to conform to, and be bound by the Constitution, Rules and Regulations of both the INTERNATIONAL WARGAMES FEDERATION, and to the rules applying o the 2012 World Individual Championships.
Signature of player: ____________________________________date: _____________________ If under 21 years of age, the legal guardian of the minor must sign.
Signature of elected club official: ___________________________________________________
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BANKING DETAILSAll entries must be deposited into the following bank account:
Name of account: MIND SPORTS SOUTH AFRICA Name of bank: ABSA Bank account #: 9047667676 SWIFT number: ABSAZAJJ |
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