Cookham Regatta 2018

Cookham Regatta 2018

Race Entry Form
Race entered *

Dragon boats Canoe-Cats Cookham Challenge Club Challenge
Crew Name
Club / Organisation (if applicable):
Contact Details
Name (First Contact)

First Name Last Name

Address

Address Line 1
Address Line 2
City	County
Postcode	Country

Mobile

-
Landline

-
Email
example@example.com
Name (Second Contact)

First Name Last Name

Address

Address Line 1
Address Line 2
City	County
Postcode	Country

Mobile

-
Landline

-
Email
example@example.com
Crew Details
Name Crew 1 (Captain)

First Name Last Name
Age if under 18
Other events entered
Name Crew 2

First Name Last Name
Age if under 18
Other events entered
Name Crew 3

First Name Last Name
Age if under 18
Other events entered
Name Crew 4

First Name Last Name
Age if under 18
Other events entered
Name Crew 5

First Name Last Name
Age if under 18
Other events entered
Name Crew 6

First Name Last Name
Age if under 18
Other events entered
Name Crew 7

First Name Last Name
Age if under 18
Other events entered
Name Crew 8

First Name Last Name
Age if under 18
Other events entered
Name Crew 9

First Name Last Name
Age if under 18
Other events entered
Name Crew 10

First Name Last Name
Age if under 18
Other events entered
Name Crew 11

First Name Last Name
Age if under 18
Other events entered
Name Crew 12

First Name Last Name
Age if under 18
Other events entered
Name Crew 13

First Name Last Name
Age if under 18
Other events entered
Name Crew 14

First Name Last Name
Age if under 18
Other events entered
Name Crew 15

First Name Last Name
Age if under 18
Other events entered
Name Crew 16

First Name Last Name
Age if under 18
Other events entered
Start time for the regatta will be promptly at 10.00am If your team has a good reason for avoiding the heats before 11.00am then please show your earliest available time
Reason
Payment
Payment method

BACS sent to 'Cookham Regatta' Sort Code 60-13-35 Account No. 67075037 Reference: your Crew Name CHEQUE made payable to ’Cookham Bridge Rotary Club Regatta Account’ with Crew Name on the reverse and posted to:Regatta Entries, 31A Victoria Road, Eton Wick, Berkshire, SL4 6LY OTHER MEANS - Details below
Payment details
Privacy statement
All personal information is kept confidential and will not be revealed to any third parties. Please go to the Race Entry page for our full statement.

Please tick the adjacent box if you are happy to receive information about future Regattas
Agreement & Authority
As first contact listed above please tick here to affirm that you have read the Cookham Regatta Rules and Regulations. *

By submitting this form all my crew and I agree to abide by the Cookham Regatta Rules and Regulations. In particular we agree that the race organisers shall not be liable for any loss, damage, death or personal injury howsoever caused as a result of taking part in this event. I confirm that all my crew and I are competent swimmers and I have their authority to enter them into this event and commit them to the above agreement. I also confirm that I have the written authority of a parent, guardian or responsible person for all crew members under the age of 18 years.
Should be Empty:

Cookham Regatta 2018

Contact Details

Crew Details

Payment

Privacy statement

Agreement & Authority