Name
.........................................................
Address
...
...........
Post code
...
Telephone
..E-mail
Date of Birth
..
Boy Girl (circle), Tournament
entered 1 or 2 (circle)
Age group entered (circle) U18 U16 U14 U12 U10 U 8
Tournament 1 Under 12 Under
10,Under 8
Early bird entry fee $35...............
If paid by Friday June 19
Full entry fee $45 .........................
Tournament 2 Under 18, Under
16, Under 14
Early bird entry fee $45..............
If paid by Friday June 19
Full entry fee $55.........................
Tick the fee applicable and
attach the required amount
Signature of the entrant
.
Pay by cheque or cash
Post entry with appropriate fee to
09 Vic Junior Championships
c/o 23 Chester Street Surrey Hills
3127
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