Section 1: Your Details (Delete As Applicable) s4

CSSC EVENT ENTRY FORM

Event: Footgolf Roseberry Grange Golf Club, Grange Villa, Chester-Le-Street, Durham, DH2 Venue: 3NF Date of event: Friday 7 October 2016 Start time: 5.30pm

Please complete all sections in BLOCK CAPITALS. CSSC membership numbers must be included. You may find it helpful to ‘Tab’ from one field to another.

Section 1: Your Details (Delete as applicable)

Title: Forename: Surname: Gender: Over 18: Yes No Home Address

Postcode CSSC membership no. Home Telephone no. Work Telephone no. Mobile Telephone no. Email

Next of Kin NoK Contact Tel. no.

Section 2: Entry Fee

CSSC Members: £5 ………… Non-Members: £10 …………..

Under 16s: £5 ………….. Concessions: £7.50 …………..

Got a group of 4? Foot golf 4 Ball, 4 Pint Pitcher & 4 Burgers. Don’t have a group of 4 but would like to participate in the offer please let CSSC know and we will try to allocate you with others in the same position.

CSSC Members: £7.50 ………… Non-Members: £12.50 …………..

To pay by card please call 01494 888434 quoting ‘Footgolf Durham’

All cheques should be made payable to ‘CSSC ltd’ and should accompany the entry form. Please do not send cash.

Refund Policy: No refunds will be given from a month prior to the event.

Payment Method: Total Amount: £

Please complete ALL details below for any attendees

Name Adult/child CSSC number Contact number Email Address NOK and contact and age (if applicable) number if different Section 3: Event Information

Footgolf is played on a golf course using a size 5 football. The object of the game is to get the ball into the hole using only your feet in the fewest number of shots possible. Footgolf is a very 'addictive' sport - it combines the best of football and golf, two of the most popular sports in the world. The beauty of the game lies in your being able to strategically combine power and precision every time you play footgolf. And, of course, it is open to everyone.

For Footgolf Basic rules please click here

Each tee slot can be booked once for up to 5 players

Course 250yds Par 72 18 Holes Size 5 Footballs provided Shower and Changing facilities available in the clubhouse Free Car Parking Free wi-fi in clubhouse

Golf Buggies available to hire on the day

Section 4: Important Information

Medical: Please let us know if you have any physical or medical conditions Yes/No (Delete as applicable)

If yes, please give details Any Dietary Requirements

IMPORTANT: These events are active and players should be aware of the physical activities involved. CSSC reserves the right to cancel the event if under subscribed.

All CSSC members taking part in the event are covered by CSSC Sports and Leisure Public Liability Insurance. Please note that this policy is NOT a Personal Accident Policy. Members are encouraged to take out their own insurance policy. This event is open to your friends or family members. As a reminder, under our Linked membership scheme, up to three of your friends or family members can join CSSC and take part in our events at members’ rate. Membership is also available to staff working in the Public Sector such as NHS, local government, teachers, the police, fire fighters and HM Armed forces personnel.

Once entry forms and payment are received and processed an acknowledgement email will be sent out with further information a week before the event.

Signed: Date:

Please send all entries to:

Email: [email protected]

Post: Jennifer Yarrow CSSC Sports & Leisure Compton Court 20-24 Temple End High Wycombe Bucks HP13 5DR

Photocopied forms will be accepted Phone: 01494 888434