Rowing Entries

Crew Contact Person

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Title: DR MR MRS MS	First Name: (•)	Last Name: (•)
Contact Phone Number (•)	E-Mail Address: (•)

Race Entry Information

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Club/School: (•)
Which race are you entering? (•) -- Please select -- Single Double Pair 4+ Quad/4- Eight	Which division are you entering? (•) -- Please select -- Open - Male Open - Female Master - Male Master - Female Mixed School Boy School Girl

Rower Information

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	Name:	Club/School:	Age:	T-Shirt Size:
1				-- Select-- Small Medium Large X-Large
2				-- Select-- Small Medium Large X-Large
3				-- Select-- Small Medium Large X-Large
4				-- Select-- Small Medium Large X-Large
5				-- Select-- Small Medium Large X-Large
6				-- Select-- Small Medium Large X-Large
7				-- Select-- Small Medium Large X-Large
8				-- Select-- Small Medium Large X-Large
Cox				-- Select- Small Medium Large X-Large

Payment Details  [Seat fee=$20/seat,   T-shirts = $15 each]  PLEASE INCLUDE YOUR NAME IN Direct Debit Xfer

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Payment Method -- Please select -- Direct Deposit Cheque •	Entry Fee $ •
Make cheques payable to: Murwillumbah Rowing Club & post to PO Box 846, Murwillumbah, 2484
Deposit Details:
Account Name: MRC HOTT Acct BSB: 082-738 Account Number: 170430070

Comments

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Enter Word Verification in box below •