For further information contact
Jo Blogs on 02 9999 1234

<NSW ROGAINE EVENT TITLE> ENTRY FORM
1st - 2nd Month 2005

 (Admin)

Team Number:
Full Name
(First name is team contact)		 Address Phone Numbers

(p) Primary  (a)  Alternate

 Birth Date,
Gender,
Novice		 Fees
Email Event Late       Total
    (p)      /     /            
 M  F
  (a)
 Yes  No
    (p)      /     /            
 M  F
  (a)
 Yes  No
    (p)      /     /            
 M  F
  (a)
 Yes  No
    (p)      /     /            
 M  F
  (a)
 Yes  No
    (p)      /     /            
 M  F
  (a)
 Yes  No
Circle answers above  ^       ^      ^     Grand Total  $  
Event Duration?
 (circle one)		 6
 hour		 15 in 24
 hour		 24
 hour
Family Team?
  (circle one)		 Y
N
How to receive Instructions?
  (tick one)		 Please mail to me. I have enclosed a DL SAE  
I will download from the website  
Late Fees apply after ** date **.                                            The Closing Date for entries is ** date **

Fees
Event Entry Adult $50
Concession $40
Family $100 (max)
Late $10 per person for entries
 postmarked after ** date **.
Other $x  per person

Explanatory Notes
For an explanation of terms such as 'Family' or 'Novice' visit the "About Events" section of the NSWRA web site. Our refund policy can also be found there.
If you do not have web access, phone the contact person for this event.

Where to send this form?

Jo Blogs
1 High Road
Town NSW 1234

  • Be sure to include ALL fees with this entry.
  • Please make cheques / money orders payable to the "New South Wales Rogaining Association".