THE INDOOR CRICKET AND SPORTS CENTRE PACIFIC HIGHWAY COFFS by npo17349

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									 THE INDOOR CRICKET AND SPORTS CENTRE
 PACIFIC HIGHWAY COFFS HARBOUR 2450
 TELEPHONE / FAX: (02) 6652 8133
 MOBILE: 0412 907 928
 EMAIL: threewayrode@optusnet.com.au


TEAM NAME: ______________________________

TEAM CAPTAIN (CONTACT): ______________________________

GRADE: __________

Please be aware that all players play at their own risk.
Please ensure that the following table is filled in completely, correctly and clearly.

NAME                                              SIGNATURE                D.O.B         HOME PHONE   WORK PHONE / MOBILE

								
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