5TH Hockey India Senior Women National Championship 2015

5TH Hockey India Senior Women National Championship 2015. Saifai. Uttar Pradesh. 201h April to 3rd May 2015 B & A Division

Participation Certificates Details

Serial Number allotted for Senior Women- 17039- 17376 (B-Division)

1) Hockey Gujarat - 17039- 17058 (20 nos)(18 Players+ Manager+ Coach)

2) Vidharbha Hockey Association -17059 -17078(20 nos)(18 Players+ Manager+ Coach)

3) Chhattisgarh Hockey - 17079 -17099(20 nos)(18 Players+ Manager+ Coach) (Cancel17081)(Replaced 17082)

4) Hockey Uttarakhand -17100 -17120(19 nos)(17 Players+ Manager+ Coach) (Cancel17113, 17116)(Replaced 17114)

5) Hockey Unit of Tamil Nadu -17121-17140(20 nos)(18 Players+ Manager+ Coach)

6) Hockey Andhra Pradesh -17141- 17160(20 nos)(18 Players+ Manager+ Coach) (Cancel17144, 17154)(Replaced 17241, 17240)

7) Tripura Hockey -17161-17180(20 nos)(18 Players+ Manager+ Coach)

8) Hockey Rajasthan -17181-17200(20 nos)(18 Players+ Manager+ Coach)

9) Bengal Hockey Association -17201-17220(20 nos)(18 Players+ Manager+ Coach)

10) Hockey Puducherry -17221-17239(19 nos)(18 Players+ Manager)

11) Steel Plant Sports Board -17242- 17259(18 nos)(16 Players+ Manager+ Coach)

12) Hockey jammu and Kashmir -17260 -17279(20 nos)(18 Players+ Manager+ Coach)

13) Manipur Hockey -17280 -17296(17 nos)(l6 Players+ Manager)

14) Hockey Pataila -17297-17316(20 nos)(18 Players+ Manager+ Coach) (Cancel17297)(Replaced 17495)

15) Hockey Bihar -17317- 17336)(20 nos)(18 Players+ Manager +Coach)

16) Hockey Madhya Pradesh -17337 -17355(19 nos)(17 Players+ Manager +Coach)

17) Association Of Indian Unviversities- 17356 -17376(20 nos)(18 Players+ Manager +Coach) (Cancel17356)(Replaced 17357)

Total Number of Cancelled Certificates- 7 Participation Certificates Details

Serial Number allotted for Senior Women- 17039- 17376 (A-Division)

1) Delhi Hockey - 17377- 17396(20 nos)(18 Players+ Manager+ Coach)

2) Hockey Odisha -17397-17416 (20 nos)(18 Players+ Manager+ Coach)

3) Hockey Maharashtra -17417-17436 (20 nos)(18 Players+ Manager+ Coach)

4) Hockey Himachal -17437-17454 (18 nos)(16 Players+ Manager+ Coach)

5) Hockey Haryana -17455 -17474(20 nos)(18 Players+ Manager+ Coach)

6) Sports Authority of India - 17 4 75 - 17494(20 nos )(18 Players + Manager + Coach)

7) Assam Hockey -17496 -17515(20 nos)(18 Players+ Manager+ Coach)

8) Hockey Karnataka -17516 -17534(19 nos)(17 Players+ Manager+ Coach)

9) Uttar Pradesh Hockey -17535 -17554(19 nos)(18 Players+ Manager) (Cancel17553)

10) Kerala Hockey -17555 -17574(20 nos)(18 Players+ Manager+ Coach)

11)The Mumbai Hockey Association Ltd.-17575-17595(20 nos)(18Players+Manager +Coach) (Cancel17579)(Replaced 17580)

12) Hockey Bhopal -17596 -17616(20 nos)(18 Players+ Manager+ Coach) (Cancel17615)(Replaced 17616)

13)Madhya Pradesh Hockey.Academy-17617- 17636(20 nos)(18 Players+ Manager+ Coach)

Total Number of Cancelled Certificates- 3

Total Remaining Participation Certificate= 17637-17784 (148 Nos)

---·-·-- Bronze Certificates Details

Serial Number allotted for Senior Women (Bronze}:- 17785-17810( 26 Nos)

14) Hockey Punjab 17785 -17804(20 nos)(18 Players+ Manager+ Coach)

Remaining Extra Certificate- 17805-17810 (6Nos}

Silver Certificates Details

Serial Number allotted for Senior Women (Silver}:- 17811-17836( 26 Nos}

15) Hockey jharkhand -17811-17830(20 nos)(18 Players+ Manager+ Coach)

Remaining Extra Certificate -17831-17836 (6Nos}

Gold Certificates Details

Serial Number allotted for Senior Women (Silver}:- 17837-17862( 26 Nos}

16) Railway Sports Promotion Board -17837 -17856(20 nos)(18 Players+ Manager+ Coach)

Remaining Extra Certiticate- 17857-17862 (6Nos} f' /lJJ?&L (/cww/ ENTRY FORM

COMPETITION: 5th Hockey India Senior Women National Championship 2015 (Div B) ___

DATE OF COMPETITION: '20 April- 29 April 2015 STATE:HOCKEY GUJARAT HOCKE!

PLAYERS Shirl Family Name First Name No. [PRINTED - BLOCK [PRINTED- BLOCK LETTERS Date of Birth Hockey India ID Card Father's (ddlmmlyyyy) No. 1-32 LETTERS] Name 1 PATEL KRUPA ~ \":fo3.C\ A 04/03/93 2 PATEL SIDDHI- \':fo'-\0 N 20/10/93 3 PRAWAStPxf.\VA.s ANKITA- \--:.}o~1 K 27/12/97 4 PATEL HITANSHI- \1-o'-n- p 20/10/2000 5 SHAH PARMESHWARI'" \';)o'-\s M 03/08/2000 / 6 Si!VG.I-f PRIYANKA~i~;!llll@t'f, K 0310719$ PI; U,U::JfOOY'1 0/XUI'f RUPARELI~YJ7 TRUPTI- \'")- 0'-\ ~ K 21/07/99 12 OLAKIYA MAMAT- \":tDSO R 28/10/98 13 GM®,,~·,,-t._;~w 4~1. PRIYANKA \ '":\- 'Q .s; \ 0 06/04/93 14 VIRADIYA AMIJA _ \"';}OS 2- L 16/03/93 15 JHA PRACHI - I 'foss N 12/10/99 Pt./ {JtU...J IV( O.:i:i 'RJSTlj :I. ' 16 PATEL MAUSAMI- \ ":1-054 N 02/01/94 17 KANDOI ZILMIL ~ \ '"":+ '0 .s:s: p 010/9/99 If"'' l-/ u, U,] ( v • 0 ...l?CilJ 18 SHAH KAJOL - \'":1-()Sf. M 17/2/97 pt./UJUJ I 01<-f¥6/'t:'0/4 Tearn Manager: DEVIKAWo,ii!JII!;!tA VAGtHE.LA Coach: ASHOK GAKWAD - \--=!- ~S C0 -- \-:t-os+ TEAM COLOURS ALTERNATIVE COLOURS Shirt: ORANGE I WHITE Shirt: BLUE Shorls: BLACK Shorts: BLACK Socks: RED Socks: BLUE Goalkeeper shirt: BLUE I ORANGE Goalkeeper shirt: (Must comprise different colour to both primary and alternate (Must comprise different colour to both primary and alternate colour colour of shirt) of shirt)

One sot must comprise at least 80% single colour per piece. Goalkeeper shirt must com prise different colour to both primar)'_~nd alternate colour of shirt. ... . ·--~-----··-

Name: R.V.SHELAR Oa!e: 17/03/2015 ;;_ -:~:~ :~·1.~ :: ··,_ . -···-- .... -~---- ("<{i·~:-.· [\ . ,.,k Position: HON.SECRETARY :S~natuy (e--- / ~' - ! -"' ------ENTRY FORM Qj

COMPETITION: 5th Hockey India Senior Women National Championship 2015 (Div B)

DATE OF COMPETITION· 20 - 29 Aoril 2015 STATE· VIDARBHA PLAYERS -- Shirt Family Name First Name No. [PRINTED- BLOCK [PRINTED- BLOCK Father's Date of Birth · Hockey India 10 Cord 1·32 LETTERS] LETTERS] Name [dd/mm/yyyy) l'llo. 1. BANSOD • PRIYA-\1-0.S9 DHANRAJ 10.02.1996 2. KHOBRAGADE • ROSHANI-\?rt>l;,b RAJU 14.01.1992

3. YENORKAR • SHUBHANGI~\1:0\,\ SURENDRA 30.04.1996

4. BELSARE • SNEHAL~\?.,l:k, '2- RAMESH 26.02.1990 -~--·-- f-- 5. IDPATE . KANCHAN-\t%S SHIVCHARAN 12.07.1993 6. BADKI TANVI- nl:lb~ DILIP 21.12.1999 7. JIBHKATE POURNWI/k \10~ ASH OK 04.05.1993

8. NAKTODE ~ KIRTI- \ 1-00b NARAYAN 10.04.1995 -- 9. ATKAR KOMAL- r:tt>E,1 DNYANESHWAR 14.07.1996 10. KHEWALE . MONALH ttlE>~ RAJENDRA 15.02.1995 11. BHOYAR LOBHA-\1()(,9 ASH OK 17.01.1987 12. MESHRAM • SANGEETA-\"41:>'10 RAMESH 02.10.1991 -·- 13. YADAV . SUNITA -\1o'::ll PREMLAL 25.06.1993 14. NISHAD • NEELAM-\ 1C>:J2 RAMKRUPAL 28.04.1994 15. KUJUR . ESTHER- \1tl13 NIROJ 12.10.1995 16. MADAVI • KRUTIKA- \ ~'({) '-! RAVINDRA 08.12.1996 17. lADE . MANISHA- \1015 VI NOD 22.01.1992 18. MENDHE • ROSHANI-\ ':)01k VILAS 19.03.1990

Team Manager: SMT. SUMAN KAPOOR- \l:D'l---=1- Coach: HARISH KAPOOR - \f-0-::J S fl$511' caacn.- /-INtiJtt'R 7rtll'i7EtJ TEAM COLOURS ALTERNATIVE COLOURS Shirt : DARK GREEN & LIGHT GREEN Shirt: BLUE & RED Shor \s: Rl Ar.K Shorts: WHITE Socks : GREEN Socks: BLUE Goalkeeper Shirt: WHITE & BLUE Goalkeeper Shirt: WHITE & RED (Must comprise different colour to both primary and alternative (Must comprise different colour to both primary and alternate Colour of Shirt) colour of Shirt)

One Set must comprise at least 80% single colour per piece. Goalkeeper shirt must comprise different colour to both primary and alternative colour of Shirt. -··------Name : VI NOD KUMAR TRIVEDI Date: 13.04.2015

Position: HON. SECRETARY Signature : 11-J.~-1 .. - : . ·------·- Note : It IS mandatory for the practrcong team to be on proper kot woth correct short n'ffate a'i'ilfa-walllng which they will be penalized. Also,it is mandatory for a team to bring two sets of ~Hi"f!W~Y:m'Ca:'&\uoo,. Nag put\ _'0!0 K L(\ 2 0 ~) C>l ~ ~~~~ (.],

HOCKEY INDIA ,. ,1rf,] 1! c9'j 1 ~ t(}r..F'r~; ~ ,'} ~~ £/ I 5"' I -rJ ENTRY FORM

COMPETITION:

DATE OF COMPETITION: _ 20 _6£r!j __:- __~9 ApfB_l_Q_1~?___

PLAYERS Shirt Family Name First Name Date of Birth Hockey India ID Card No. [PRINTED- BLOCK [PRINTED- BLOCK LETTERS FNather's (ddlmmlyyyy) No. 1 - 32 LETTERS] ame

-~ :-o.1-H N bE • lr,.. 1 t<.l -\'Ire ~ 1- '" 1<. RM 11 & o1-/ r.o,sLJ

TeamManager:.$.!>•J:'f. 'ff\Mi1-.JE6$H .SHUkLC\ Coach: 'RilsH'MI Sf\~t>H'\ff\, E.kKf>t

TEAM COLOURS ALTERNATIVE COLOURS Shirt: "/ E= LUYI.V Shirt: R8.1> Shorts(s klk M At'ZouN Shorts:/ S.\:..i-.~~-k _ · REl) Socks: MAR.OO,N Socks: WHITE.. Goalkeeper shirt: [SL V E Goalkeeper shirt: (Must comprise different colour to both primary and alternate (Must comprise different colour to both primary and altornoto colour colour of shirt) of shirt)

One set must comprise at least 80% single colour per piece. Goalkeeper shirt must comprise different colour to both pr!mary and alternate colour of shirt. ·--

Name:

Position: Signature~ Note: It Is mandatory for the participating team to be in proper kit with correct shirt numbers and colors, failing which they will be penalized. Also, It is mandatory for a team to bring two sets of Socks (to avoid any color clash). HOCKEY INDIA

ENTRY FORM

--*h k . . t' ' I I ./ I' A ~ 1' COMPETITION: ___ s______J:t.OJ:.... ~-----J:~a...... -2.~hW.J:... UJ.Il~----NtWP.lNJJ/,.. ...~Milii.Yf ~f>, DATE OF COMPETITION: . - __ :l,D__~---~f:D. __2_9__~ __ _/dpdl '2{)~ STATE: ______v.J;iNY;;_lb~.yj______.. I PLAYERS Date of Birth Hockey India 10 Card Father's Name (ddlmmlyyyy) No.

I Team Manager: tf(ps WI.K/1 .s r D DitW I Coach: MtJH17 '&t.J.&T- \3-\20___ . ' ______---L..:I._U_L_ n,v~, __ ------TEAM COLOURS i ALTEJRNATIV2 COLOUR~--//, Ci't__./(" Shirt: Shirt: rJe uJ v-v.. l 1/1, {>L 7f: cr . I Shorts: Shorts: ,. ~, ,.. t,j Socks: Socks .· r-1 / ) S, ti

, Narne: Date ,::-. ' ~- .. ,;,~n~ I Position: Signature J.-._ • ~ ~---- Note: It is mandatory for the participating team to be in proper kit with correct shirt numbel-§'ifnd colors, failing which they will be penalized. Also, it is mandatory for a team to brfng two sets of Socks (to avoid any color clash). HOCKEY INDIA

ENTRY FORM

COMPETITION: ___?.!_i} __lj_Q9_'s_~y_ __ lf!_cl)~--~!?_Q)QE__'!:!_Q_f!l!?_f! __ ~~!iQ_t:l_~I __ Qb_~l11-~i_Qf!_~_b)£_.?_Q_!_?. __ (_g)_Y._§)______

DATE OF COMPETITION: __?.Q __ ~~r.il_::: __ ?,~--~~r.\l__?_Q_!_?. __ _ STATE: __ j_fil:1lJ.-_tli_!'l!)_u ______

PLAYERS Shirt Family Name First Name Date of Birth Hockey India ID Car No. [PRINTED- BLOCK [PRINTED - BLOCK LETTERS Father's 1-32 (ddlmmlyyyy) No. LETTERS], Name ~- "''..A" \ 'l--\'2-\ VI . j)n; Pfl lu M•Un»qwu l:'illllllrO,o,J., \% \ '1-1 22--, A. \{f) IV\1-11 I<' A 111. llRMI\ I~ lllh II o. qr; A \ ':\- \23. ,. ':!' . 1-< AU-H VRNI '1"'- 07 'o, lt"lO.b. I lA \ 1--1'2---'1- ' Q :\I'IYA I.AI<.SHMI <0 .II<>VI loR 1111'19.'i I( \1-\ '2-9-, • I':P. ._:\E.LflST\l\JA ~~ 1/r,.c; Jqq~ A. \1-\ '2-C(. I'M . 'K'E'I': 'R.T\MlWR Ill.. >1AI nvnlto 111 mt 1o.o.f. tO \'1-13-a' 1 , A . j.{ Q I.S 1-\ N 'A M "'"''"'I In . "PRfl~u IMfo,_, \"'qi /ll \i-\3\ VI. M I f\\'l 'A "' 't.< I LO lm 1996 A n-1:s2· f) - Rfl¥1 f) .'DEY I S. Sur.>.:l'Ul I~ laflqO.L ¥-- ~ \1-\33, s A::-rAV S ~-J E Tl.Jrl lf.~UI lnt. Int. 1qq t; Pt- /vr~>~lot~;..-:,/; %( 1 '1-Js y II. ""' ''\li1h RP"'-u'WI 1 PAl"!/ 'r-. . /n"7 /1qo.r:. ....,._. ~- --~ \ 1-131-· R - SELVA PFINI N o."'> n.'l r q .;;-:~ A l '1--13 ~ • Q. :t"') E. I' P\ 'k' A Wl. 1ln lm I I"! "'I Team Manager: L 'G-.l:JN""S<.H-ll>ARI Coach: L-· N. """-u-r - _\3: \ '-\ 0 I':I-~ C1 TEAM COLOURS ALTERNATIVE COLOURS Shirt: Re..cl Shirt: fl ~cy BLuE. Shorts: WI., I<\-"-.. . . Shorts: }'/!,;«--· V>~[\Nt,•t; gll1c ~- nge W·l'-tfl 8/o..cJ:; Socks: L ~;QYI<. .>.J •1 Goalkeeper shirt: ;.,_, ~).,1:. C1 1""- '-1 Goalkeeper shirt: }..-•;)·/; q""':: J!, (Mu sl comprise different colour to both primary and alternate (Must comprise different colour to both primary and altornolo cole colour of shirt) of shirt) One set must comprise at least 80% single colour per piece. Goalkeeper shirt must comprise different colour to both primal]( and alternate colour of shirt. _,_ -· • ... c -- -·--

NBille: IV\. l2e.-"' l.J 10\ LPr 1<'-!: L-#1 J Date: 1r- otr. z.o ~~- ~-:::'~::..-:: . ~ ~11' OF r.,1 ~ / I \) ..----...... •ff. '\, Pas ilion: Cce.-)..] "'"-A t. Sec '-<"T A-Jl?...<.j Signature 1· }nuf.. .L.h#n., · . ~y· .}•: _ '<'.z, -·-·· .. Note. It 1s mandatory for the part1c1patmg tea to be m proper k1t w1th c rect sh1rt numbers a ors, rf_/.~Jtr_.~\y~\111011 they will be penalized. Also, it is mandatory for a team to bring two sets of Socks (to avoid any ~-clash~.;·-:-: 11?.ii: \ . . .•.,,, ,'\::\.. ' * J.'l':j'~l':\(.'•)• ·:·· I \ - -~\,·,,~JI~.·' I ~~' r~.~~.·~.'t-':'· .." /, . \ ....'(,,~ ·-:.. .• >- .. ,.1 '·-' ·, ·,~ ....._ , ,f' I . :;- -.. __ ..... •\' /1 '\ l,j . ,_ ' ' .. , '~·~ .. ~f)t·;.,., •• lltll••' .. ,(/ ' I

~ ,. 'i,vl~ ~ ~ ffrVt?-ot~!{z ~ HOCKEY INDIA

ENTRY FORM

COMPETITION: ~~~--':1~~-~ 11. ~ -~ip_20 1_~__(.1)_ i v B) __ _ DATE OF COMPETITION: ---~.9.:~~~~~-~P.!.~!3g_~-~------. ··········· STATE: TRIPURA ··--··---- PLAYERS

1 ,..,,,,,, hunflyNamo First Nome · ------····:--- · --_·:····-··r-----··" ------· No. .. . {PRINTED- [PRINTED- . FDtJwr's Name_-_. . J Date of_l.~/1!.17 Hockey fnc!}o 10 Card I 32 BLOCK BLOCK I {dd!mmtyyyy No.

! f -- ___!.ETTER§) .- p~?~1~~lt:.)~ SHIV KUMAR ..... \j-J..br--=j _16/~~i{gg(f! ______:~~= I 5 __ __:>INGf:i__ • _PRATIMA ... YOGf'NDRA SINGH \'1:\62, I2010Gi_1_1J_~:_[___ --- . ------~--- _~~GA~--·, ~~:;TIKA ~~~:~ :::I~GH\'N~-+~:;~~;;~:;~+- ______... 1":it BI·IA-DAURIYA; KIRT(- . . RAJKUMAR BHAclAVRIYA Y:-t\?t"1lmi1iiu3 r·-- ~~~LJ VISHAS~A '~ :~I~A --- ~~I~HKA~sb:~~(jp;~i~~+~~~;;~~~-~~=~:~~~----~----

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i Too1n Mw1ager: NUS RAT A_L~KHIIN \":}\ 1-C\ Coac_h: __ ~· A. KHAr::__ __ \ '"}~~ Q_____ ~------·------·------········-----···----- TEAM COLOURS ALTERNATIVE COLOURS , St1irt· HI:D Shirr: RED i

1 Shorts· fli.ACK Shor!s: BLACK I Socks: BLACK Socks: BLACK Goalkccp(tr shirt BLUE Goalkeeper shirt: GREEN (Must comp1ise different colour to bolh primary and alternate (Must comprise different colour to both primar; ahd <1!temate colou; colour of shirt) of shirt)

) 0110 sot' must comprise at loast 80% single colour per piece. Goalkeeper shirt must comprise different colour- to botl1 !· P.!!_,_n~_ry_ !'_lld alternate colour_Qt~~------.. --. ______, ______. ----··

1 Name; Jayanta Bhowmik Dr:tle; 28'"' fvJprch, 20·1 5 ,., ,_._, .., 1 I '!l-1 .- ·-IA/,J.A .-;·.I; ' ••; 'l _.r.....V)IV'--- 'LA..

. ----.------.. ______... propGr kit wlth correct shirt numbcrS·a·J-iCfCoJors, failing \-V"tiTCh__ ... they will be pe s mandatory for a tearn to bring two sets of Socks (to ~wold aiJY color clash}. ~ - Hony. General Secretary ~ ' Tr ipura Hockey. ' ( MANAGER TRIPURA HOCKEY ~~~ L~~ l ''\11/; :.:;~.... 1/tt~:.) ~.~~~ (. ::::;_~:;§::Jf~~ Cf'J '""'>. t' :.-;: I \'\':'""'. '· ( •. \o" HOCr:id lt<:.,.i:\ ~/VV)~ 611. <;, . k,~(__ ___E_N_T_R~Y FORM 69' CfiL1 Q__qJJ g-zs·-·-

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1 1 ·r ;.: ;.. ~ ,'J c: ~-~ ~- r~ • ;~.s Ai.T£Rt./AI!\.'E COLOURS s:-. ,-,- :--< ~-l 1 -~-~ [ ('~ /.. U{ OAAMo,~ ~ P-.1 .A-~Ct( S;r;n3· t-~'-{l;t. S'\ily- bLu € Ss-.:Ks .._ ~ ,r~,'M V r- ~~\l.C·1 f' ~UH: . .-·~ ~ .• . " . ' .. Gc a!~e<;:t~c-; :::.fhr: .:.·:··.:··-::~: ci::s~r.:.-v. c-:~::~:~ :::.: t::::,-. ;::irn:::;J ant! a:t'.::~ra!e (M .:st c0rn;;;is:: :!liferent colour to both pri:.wry anJ OJI:c:m8te ::.,·.:.:r.:r oh:hirt)

.";.:!·-,: ..:o:-nprise at le~:.t 80% sln2le colol!r per piece. GJaJXccpcr shin mur.t comprisp different celom to boli1 _,-_.- ;~ -_~,~~-'=--~co!o~_·_ __::::!· .0:J.1· ~-----····------______------______

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s·.:;;:~;;: .. ::::· :~::::ory--f c ~ tt: s i~-;·1-:,7:c·:·;; ;:~-:~19 te;il;·~·o be ;i,--~-ro per ~:;:--,:;~:-,1 ·;:·o;ro-:::tST-ii;:tn'um bers·a-MiCGTors~-fJiifr1g\:;";~iCii_____ - -.::·,::-ll;z._::,"· .:..iso. it;:; ~-:-t;:i:c-:~,~r; for a le::>m to !jring ·:·.·,•o s~=~~: of S(Jcks (to avoid cny co:0r cl<~sh}. t /· f9JO 4~o HOCKEY RAJASTHAN "' I /y jfJ~ (Affiliated to Hockey India & Rajasthan Olympic Association)

President- Hony: Secretary Or. Shobha Singh Mr. Arun Kumar Saraswat 31, Krishna Nagar, Bharetpur-321001 Hind,on Gate, Karqli TeVFax:05644-222144 · Mob.: +91-9414272437 Mob.:+91·9414023214, +919772705555 "''0{-'.a:pC.~~~ • 1:>::... +91-9929176688 E-mail: [email protected] [email protected] ~·~~ .. ~~~

Ref. No. Dated:

VIce President ' Mr. Shallendra Singh 20 m 29 m 2o15 WP ~ · ('iO.>r.) it

Mr. Mohd. Yusuf -w:x=t. 'ifll'l I ~ C'l·l-5 I . .. ~ \nf· Smt. Muktl Bala Sharma 01 llm.~. 20 CfliT Smt. Padma Naruk~ 02

Ofi ~l'f11<;'11 25 CfliT .. '011"1«1 20 Joint Secretary Ol CfliT 011 'll'Cii'm 28 CfliT Mr. Malkit Singh Maan . oq ~~ . 21 CfliT Mr. Pooran Rao (DIJ w 2.9 CfliT - ---. Mr. Kuljeet Kaur 1~ ~w=rr 18 'qt;{ Smt. Divya Pradhan . q;fcrm 22 CfliT ' " 11- ~ 1-3 ~~ 17~ !.I• 1:1{ 1~<1"'

Mr. Lokesh Meena .A-: ..,. .. _4::;,.... i~ ·· · nf-4u:af1Riq ~ Genera\Se~ BeckY &.ajastha& r~.''' . ~~ £o {'~rt-.. 0

HOCKEY INDIA

(\.A P-o¢; Ill A 12..A.!);}~ - Mlt-"~/l:R. ENTRY FORM ( +1-<><.lc.~., '?'~~~~·) . D,eoS'~IF73S73 COMPETITION: --~~~__ lj_gs_:_~ey _ _]_rl_g!_~_§.~l1i_Qr __ ~Q':!J.~!:I .. t'!9.\!9.1J.9J_g)l_~_'!!!?.l9!1Sh[p__ ~QJ!?__{£:)_[',/ __13l ______

DATE OF COMPETITION: ---~-Q.6J?.rJJ..::... ~-~-6J?.[j) __~Q_1§_ __ _ STATE: HOCKEYPUDUCHERRY

PLAYERS Shirt Family First Name Date of Birth Hockey India ID Card ~ No. Name [PRINTED - BLOCK Father's Name .. (ddl.7lmlyyyy) No. >.• 1 -· 32 [PRINTED LETTERS .j -BLOCK LETTERS! qt S. DEIVANAI (\IL V.SEKAR 19-04-1995 t; \~ 11-2::2!\ A. SHARMILADEVI P.ARUMUGAM 30-01-1995 ~ 1\.Y \'1-Q:fZ...'L PL..!PuD lollt&/?c 14 S. BHUVANESHWARI S. SUBBAIYAN 26-05-1995 .....r>J ~ \~12: S.PUSHPALATHA S. SUBB-AIYAN 13-12-1997 PL/PUD/01491/2014 ~ cY \q..--2?... '-1 '>; -~ \qq_'LS C .. DEEPA (C. ) K. CHANDIRASEKAR 02-12-1998 PUPUD/009::;5/2014 ~ LY jq::nG• \(:TAMILSEL\7]) 1:' VELMURUGAN 11-12-1997 PUPUD/0'149412614 ' -~····"-· . v ~\4~+ R. RAJINA N.RAMESH 29-07-1999 PUPUD/00952/2014 IV t-: 22?:, K RAJALAKSHMI S.KUPPUSAMY 19-02-2000 PUPUD/01489/2014 )'.. _)4/ \:J:lL..q R. RAMYASRI RADHAKRISHNAN 13--04-1998

') S.ABILASHA R. SENTHILKUMAR 09-10-1996 ~ .... T fh~ S. ABIRAMI R. SIVAKUMAR 16-08-1996 ~ ~ ~· i lOB' \-::j-23'(-- S. JAYASELVAKODY T. SAMIDURAI 30-01-1997 I t !~JY \~-;5, V. VELVIZHI M. VELMURUGAN 09-04-1997 I~ \1-~'-1" R. RANJIDHA l,k.. S. RAVICHANDRAN 10-06-1997 =] S.GNANAVALLI V. SINGARAVELU 09-01-1993 \Y \':i'l.S.S• ! \/1' 1'1~' P. SUGANYA C. PERIYANNASAMY 19-11-1997 ../' \'".1'231• M. MAGLIN STELLA MOORTHI . A- 24-09-1984 \..% T. DHIVYA M. THANGARAS \J 06-12-1997 PL/PUD/01497/2014 \'.iti~ -- Team Manager:. A. A .!?.oa._ u I fl 1\! A _').j"f: Coach: -- 1."--\ L_5'-\ TEAM COLOURS ALTERNATIVE COLOURS Shirt: Royal Blue with Wight Shirt: Shorts: Royal Blue with Wight Shorts: Socks: BLUE Socks: Goalkeeper shirt: Goalkeeper shirt: (Must comprise different colour to both primary find alternate (Must comprise different colour to both primary and alternate colour of shirt) colour of shirt) One set must comprise at least 80% single colour per pie•;e. Goalkeeper shirt must comprise different colour to both primary and alternate colour of shirt. · · · - 1 ,":.') ,·.;:. ' //L-~;£ Name: R. EJILANE ' . .'':;o:·\ Date: 15-04-2015 -r~,.· . ' .. ._ .- \ ' . . \ ;·, ':; : : ·. l . . ; -~ ; . "; ~.~ }·~- I Position: HONY. SECRETARY Signature: : '' : .. '-_._;:. : ;,\f"Y __ ..... __ ... ' _,_ .. _ -- ,_, ·-·"-' _____ .._ ,_, ___.__ -- .Ju..:.: .... ;:.-•...: .... .!1'• __ ,.___ d_ t: ... -__ , ,_,_ ry tor the partrcrpating team to b·~- i~.prO'p .. .9.. !hey will be .penalized. Also, it is ma1'1datory for a te·am:tq· ~ling two sets of Socks (to avoid any. <;olot G.iash),. / fec.e~e.d \ ~ (e. -t;\\'~o.:o.\ -

~~COMPE.TITION: --~-~~ .. f:I.~~

DATE OF COMPETITION: JQ.f'IP.~il.::-.. ?~.£-P.r_H..?_O_l_~ __ STATE: ...... S..f.SJ3...... ----- PLAYERS r-Shirt. Family Name First Name Date of Birth Hockey India ID Card No. {PRINTED- BLOCK {PRINTED- BLOCK LETTERS Father's (ddlmmlyyyy) No. 1- 32 LETTERS] Name .....-! ~. __L!\ \( i2 tl f.<. A-T V\U M 1t R 1 (41cS 14~W'$l • c . C: l(N\- () ~- :1 • 8.1,1 l r-- ~· f.v..KA- n-2.~"' 5 ~ - Rl'llf- s .\:t-," " ~A ~ "' ( e )..., .-. 13 • K Sill'~ 11 q.,_.qt, t ';:t 2 '-\ s t • ri..A U\- SHI\Stll / "' () • !(II}..fl. ~?6 .. .,. .. 52> t ";:)- '2. 1..\ b ~~~ 1<. 1-1 fl-Too 1'1 ~Ob: IUt'l ' lu. KlfiiN t'l- Df· qj, \'k '2..'-l~ • FJ.l A-N • II · 3 • 12.1 Pr I '"- • s II /.1:1!1> L- _'12-- 122 '-\?-:: . lq \lf'tr>'lrV R£(.1\J 0 L· P Y~tJo/1 DJI• g • q q \1- '2.'-\ q + ' VERMI'r D 1 v~ A-r\1 l ~ 111 • K. k'W'/, :1.'1·/o·L/O \"+..25 <:?____ t'!> \ i> ('14al¥P...~ M E. E. 'N f.\- • T ·rJ.11:w o£ .9A·FI·-1oo!l. \?-2-.S\ tf fZfr:ltl:.K N1£,f+fr ' G,·lfflinK to·EL97- \1--252 e . \'1- '2...5_3. I. ·-~~- g, 1-ltf 12.M II- rt+ KI\VI J·K·Sttf'R."i ,_,~Hl·% IS _J~ EK~fr Sfi-N'JU • 'P· E.IC KA IIS·r·,qr 1-::t '251..\ . t'>ltll1. H ~fW/1N I • I 1\1 iS· AbRI-l ilo·M94 .'~2SS ·- ..-{i cn'iR1 P·o o naJYl • l·ll· 0-ri ri 1..9o · '1- • 9ft r:J--'2-Sb ' .SINCU - to·BII-J..!J 11 lt-1- ~!I •I'-. 3'1 112S"}- Cf -~-~~ . i ·- . . ·-

- --- ... - ··-·------Team Manager: fle 'j'j:' Q Tl Q](b. 1/ Coach: ,S; U D1\ (2.__$1 4 N ~ H- ,.- \1: ',2!; q r s ,('{ \ ~.\-- '7_ c:;- 'fl -- TEAM COLOURS ALTERNATIVE COLOURS Shirt: ~.e...,f Shirt: 0l

One set must comprise at least 80% single colour per piece. Goalkeeper shirt must comprise different colour to I:Joth primary and alternate colour of shirt. • -.)I- ,-... ~rn\if~i r\ l~A . :. A''·l...:.' ' I'· t .• '· h ''"' ·' <· - t (Spo Name '{JeTe P-.. TJ R.Kc;;. /li ... """{"'.- Date I .. ;, ··- ,,,;;}!\/ D.l• ' \ I0~ 5" --n·:'.l.j 1 1-. >'·"'•· ·' ··' ~ 1 · 31-H·'fl o · 1 I r· \ ESP 0 q ~ (L. -i•~:'' ·;.. ~~ --~~i.J_y.n.l.- Position ..Jvj)IIASI!/f Slllftilf o 'f1l7'f-SJ _..--J. v\\d\~ \1\'V ENTRY ------FORM COMPETITION: -~!:l_!:!QE~Y. __I_[lQ[!!__§_~I)lQI_WE!!.i~r:!-l:'l.~~on_~!__Ghal'l!_[>jQ_Qg•ip_;2_9_g; _ _{QlyJ!)______

~~DATE OF COMPETITION: 3.Q_AR~.I :-__ ?~-~_e_r:[l_?Q:!.~ __ STATE: -·-·· __;[~':: ...... ----··-·-·- PLAYERS~~

~~{PRIN rEo- BLOCK LEn-ERS Hockey India ID Card Father's No. w;~~

~~• I -~"66P "' I RA!.I-IN E:Gi.-~~

TEAM COLOURS ALTERNATIVE COLOURS Shirt• !.£=f) )<: !J>{q ~ Shirt: ' ·Shorts: f3, ( 1\ c. '<. Shorts: Socks: ~ ~ D, So·~ks: Goalkeeper shirt: Gc a! keeper shirt: (Must comprise different colour to both primary and alternate (M 1st comprise different colour to both primary and a~ernate colour colour of shirt) of '~hirt) One set must comprise at least SO% single eolour per piece. Goalkeeper shirt must comprise different colour to both colour of

~~Name: 1\._vM A- L. _$ I "At c; H Date:~~

Position: ~E ~{'[? IZ.f+/...... SKct<.~7A:IZY Signature• ===-====::-:-•==-::c===::-::-7Note: It is mandatory for the participating tc ==-i-:-===•m to be in prope ""'""~,.,-----kit with correct snlrt numbers an. 'colors,- failin9(1Nhich __.1 is mandatory ··or a team to brint' hvo sets of Socks (to avoid aRc< !or claf1~r

~~~S·e-,·5:~~ t, -~· ' ··•-·• ' ... HockAV Jc::·,, / @,A~ /7 (>0 _fk~'~~

~~J ~ G3 6bf ~OCKEYINDIA ~15 qf ~1/ . ------rillj oil ett1°71}7J ENTRY FORM~~

~~COMPETITION: ------.-5th Hockey.. ------.- India Senior Women National...... Chamf?ionshin------______..t: ______2015 (Div------B)----·····------·~~

DATE OF COMPETITION: ---~()__ ~P._rii_::: ___~~--~P.!.ii_?Q.1.~--- STATE: MANIPUR PLAYERS Sllirl Family Name First Name I Date of Birth Hockey India 10 Card No. {PRINTED- BLOCK {PRINTED - BLOCK LETTERS Father's (dd/mmlyyyy) No. 1 - 32 LETTERS] Name l--l_I§ANJEN9At.1 ·JENMY • s. N·S llO-Ot-tCJ9:t \']-2__1\0 1 !5 ~~kl-luLAMBAM ·1\tr HA OEVI•I 1. I. S ll,-03-.2001 1~2~\ 2 NC.ANGtClM •f>R.t'('A C.I--IANU•I MlitVt• ITW.IQI.slo2-oa·J9gJ 1'1- 2.8--.S 6 ITAI<:HtaLLAMeAII'ii•J!:>R.IYA!OATI D!:v• '1 T. e.s lo!>-0.3·1SI93 \'1--l-'66 I--__I fAIII/•1\1 I~MALA .!:>evl• IKI..f.1.9IIR.-o~-1~9.2l \'1--2'elEVt• TU."''·S OI·O~·I!)if r :5 I 01 1\JAM ~NGAN<1!BrToN DEvt •I o .M s.lc11- 03·19961 \1- 2 ~ ~ 14 I TI-IOI-<::cl+oM I·~

~~Team Manager: coach N. SO""' 0 R i.JI T Sl N GH \'f2.. ct (,~~

TEAM COLOURS ALTERNATIVE COLOURS Shirt: SK'f BLUE. Shirt: Shorts: 13 1.... A c.!<: Shorts: Socks: SK:'\ 6LU E. Socks: Goalkeeper shirt: R. E. I:> Goalkeeper shirt: 1\J' AVY E:l t.. t) E. (Must comprise different colour to both primary and alternate (Must comprise different colour to both primary and alternate colour colour of shirt) of shirt)

~~One set must comprise at least 80% single colour per piece. Goalkeeper shirt must comprise different colour to both rimarv and alternate colour of shirt.~~

Name: SCJtJ~AI ..JAM SUI\lEETA DlE:VI Date I G- D-4--;;;;; D 15' .- Position: lo--+0 NY. GtE N • .SEC~'E. .,-A R "'(' Signature: S:. ~ ,(jA__.· Note: It is mandatory for the participating team to be in proper kit with correct shirt numbers and colors, failing which they will be penalized. Also, it is mandatory for a team to bring two sets of Socks (to a.~void any co_l9~_£1ash) . • -:l.tiJJ 'I· ut.,t . .:>,;·cr•a•l_r J.i;ulip>Jf H

~~..-:>' = ~ ~--s\ v-.6_ -.e.f' \--.l....._..._,_;::l\ HOCKtl'• INDIA ENTRY FORM--- COMPETITION: ...~!-~ .. !:!.~~

~~DATE OF COMPETITION: __ _?Q__ ~P..r!! ::: ...?.~ __!'![J~iL?Q_1_?.... STATE: H_Q(;_t:..£Y. ... ffi.T.l.ALEL ......~~

PLAYERS shirt _ Family Naine 1------·------F,rst Narne ---- -··r·------No. [PRINTED- BLOCK (.DRINTED. BLOCK LETTEFI.S Father's Date of Birth Hockey India 10 Card 1 - 32 LETTERS] Name (ddlmmlyyyy) No. i f:: ll uP-.. ,. · - (r,oR.PfN D E.R.(~.J:,L_- ~'t~-8- oH '16 'r'-vrc-;-3:__1'i-'f 9f /~ /Cr:JttR • rAhi[JL.___ .

~~I v s:l I 1-A-' , -L , ~ ~ 0 N AL-I { R.:OJ +~ 1\.UWB~lfL _!j__:_Q_ - 'I \ '?r 30 3_ I • f3'C-ANT ((i,1}__~~ o7 -oS-L \1-3a'-\ ___ _~~

~ 1 • Mtc.Nu l__C.·f-)_~UW!l?.J_o-o'-t-1.1 \'3.:_;.so~-- • _kuLWtNOfR. (L__l_)_(d BA~/1\l~tUU -o?-t'~ ~OG :JARNI'Il~ · \ ',\- 3 ...-r · u - e£flillt.EP (_f:WJ 11. /3-M.-I'l~ 'D--::t- go I ~=Lt •. . t;ee;w (H·BI , ,:,•• ~·o7·1~';/ \C}3a\', _ u !_ !OE:fP __{_l::l·B) __ SOO._tt;J~ -15 -I ~'i \3-30C\. 16 !J.ldB~- Lhl.U.I R! £ _lH,j))______fJ s1 -~-.3!1 -o t-=-tlJ-4---~"':\- 3\ 0 _ I lu . u --·-- &lJ..'Jf~W- VJ--D '_rJ_';f"-aJ_-1'1'1& __\23-'-l __ 1_~ ------~-·-·· _f}t-.15Hf/Z8 ___{.__f,_J,;.)__ __ iliSHVP-ER _u'_Q~ -o,;}-Jq.9.1[_____1'?c3\ '2. L /'2__ E__ ---~-- 131lt3'! ___(_f___h/_L __ ~~~-JI

~~TEAM COLOURS A·.TERNATIVE COLOURS~~

Shirt: ORA t-1 6, ~ Shirt: G-J R.EY Shorts: 13L.~ G/<. Shorts: 'f [L.LO W Socks: OR.(l 1'-.1 C-r £. Socks: 13 LAG/< Goalkeeper shirt: P.L (J E. Goalkeeper .ohirt: (Must comprise different colour to both primary and alternate (Must comprise different colour to both primary and alternate coloL colour of shirt) of shirt)

~~C;,e set must comprise at least 80% single colour per piece. Goalkeeper shirt mt·st comprise different colour to both ri~_and alternate colour of shirt. ______~~

Name: /~ IJ.) Q V\t i. 1'~8 ~ Han n Date: 16- 0 '-1 - /.)- ~ . F Hockey Patiala Position: ptfiLS ) (:; [:_ {~ S1ynature: _:J______Note~: It is mandatory for the participating te~m to be in proper kit ·...vith correct 1i. mbers and colors, failing which they will be penalized. Also, it is mandatory for a team to brin(~ hvo sets of Soc t:> ,ilvoid..any color clash). . taenttsecretary/Casbter I ~e_Ufl <.; /(Ut>' w- ·.~1 HOCKEY INDIA e::_ c:-,;~'b-~

~~ENTRY FORM~~

~~COMPETITION: ___ 5.!.~ __1j_~~-k_E)y __ lll_cJi§__~~-lliQ_r__ '{I/Q_rT1~11--~-<3-~~91l.<3! .. ~b.<3£rl()i_~ll-~bifl)_Q_!_S._JQ_i_~ __E3 )__ .. _. ______~~

DATE OF COMPETITION: ___? 9 __ f'::Eii_::: ___?.~--~P.!:!~-~_Q_1_~--- STATE: BIHAR ------, PLAYERS ---sliiiT---~-7=amily Name ___t_ First Name . --- -:--- No_. [PRINTED_ [PRINTED_ BLOCK Fatfier's Name Date of B1rlh Hockey lnclw ID _J =- ~2_ __ _?LCJS:K LETTEF3§) __LJ_=TTERS (ddlmmlyyyy) Cm~tv_o_. _ 02- SH/171./'7/1 V/I!.S/7'/J,LJ • M/1#/IVEE:R.Sh'/l~/1 Jo-o.£-1989-1- \1-sl':l-- 1 ti ___ 2>J-:;iv_i;~- ~5-h>Ji:LT,-7 ' 'J!;W}T/Jj?N/ll'i,t/Y,7- 17f?J< fri_-2:_\~- .:~-~~?_-~-:!iX~:!OR_=~-~~~;,;--;;;~--;-r; · _13JN2JM MJNJV?? Je;!-olt-1991 \ 1--2,\ q 11 1-..S/?AJEJ.S.Z /lN.?T/1 • P-NI/7/NI?. 5/lW/J~Z JJB-1,;?-/985 \"J-- 3,'2_0 --~i--p/i.'.'~EY-- .. Hfi/:,iJ/lJU; VI:REN2JJ'?/IYJI'IN7JEY a9-oJ<-J99o \"'~ 32\ -~--~_]:~~~~=---=- {i;:;;;;_-.sOS~N• f!:./1/lC~'C.WS ,8$C1k O;l-1';!-1992 \'J-322... ·-.2.0 ------+--.' i J(UM/1/U ------::DfjL.Ly------' ;DEV Nl'lA'I9Y#N .S/N&# /o -o 8- !9 9o -\_'Jr._3_ 23_ ___ l? __ i_-!'~::':.:'_~E_Y___ .:r_c_q~!_--~--- /lllk,E...~h'.Kli/WIR:t'tWY:JJ.Ey o8-o7- /990 \-:\~~~ 1 __ ~§---f~_!~c:;:~------~~lf'~_:z>AJ!C • 1/:T/ly S/IVG/7 !5-o7-/J9.3 \1- 3~5 __ 1.<, l.kOIW?:RI , NJSh'/1 • 11/1-..;;.JJJ="£/?':t'A'HG"/JZJ Y/1:tJIN ;u-o.3- !995 I '" 32_E, I· ·-o·_s· --~--it'.:9No _____ -T------;-----~l'?llN££/rN/1~ !5-/FZ- ;9,9o ~--\-32?--- .:~=BI;~-i -!::i~(J :;':":::';/~;;'/ ;:-:-;::; ,~:t~ I -~ ~i __ l3i~~------i~~~_!.' ____• _____ ~:RJ$'VR/17i'.l S/N~ . J.S-/1- 199S \} 'S'30 I __ _9~--~~~J>:ti'?R.J' ----! M!!"N_-!___ _. L./tX.PIA.N .kJ.Sn'-'1'? $/Nt;_ij ;<;!-o/2 /5' 9/ l' l- 2,3\ '2 _9._§_ __ I!''OPI!!'A'-"_____ l~1"'(<'!:' T":_ __• _,:BHJM ~EN of-//- /9 9 7 ,>dr>.?;h'/1/V :~~:~-~;;~: ~:;1:~ Te<>m Manager: c.9UN-.r"T/? ,k.UM/l/(.7 Coach: N/lAI'-':T KUN/1.7( - \ ').. 3._3 b

~~-----·------I TEAM COLOURS ALTERNATIVE COLOURS Shirt: Y EL.L.oh! e '7:£7> Shirt: ~/i:ll E YELdoN Shorts: :BL/JCI c: Y£LLot,; Shorts: SLI9~~

Socks: YELL. ON & /lEZJ Socks: ;REJ> !!- YE?Lt!/J Go<>lkeeper shirt: o1M#G: £ Goalkeeper shirt: #.4YY2JL.o€-r.V.Y :BL.Uc (Must comprise different colour to both primary and alternate (Must comprise different colour to both primary and alternate colour of shirt) colour of shirt)

~~One set must comprise at le3st 80% single colour per piece. Goalkeeper shirt must comprise different colour to both~~

~~. pNrimary:;'::;;o;;;~;rt~:;~#~-----· t -o.;,.-;:!o;.s- 1 ame: 0 a e: 17~~

I Position: GEAIE:R/IL- S.Et1RET/?:A!Y Signature: ~ Note: It is mandatory for-the-participating-team to be in proper kit with correct-J!hkl!'umbers and colors, faiHng which they will be penalized. Also, it is mandatory for a team to bring two setslf'$~~~~id any color clash). . ~{\ -·--...... "-t.' /""'Y, ...... ,~_ .\-a \ ro 'T:;;> :y~,-).~,·-~ .~ • .,. i ., ' ,\...... _. •.....:,.~I ~~; :~.. ~~ ... /

~~;y/ J!t ~ ~ c}Jr - ~ HOCKEY INOLa. oc! ~y ~ 0 ENTRY FORM~~

COMPETiTION: ---~~t~.!~.'?.~~~X.}0S!!9.. ~~-019.1:_Y:Y:9.f!.!~.0-~.?.~i-~~!3_~l_9!_l_~_f!'2!.c?D.~~-iP. ZQ_-!_5 (_Q_iyJ~l... DATE OF COMPETITION: STATE: __?_Q __ ~P..~!L-:: ___?_$_,.~P.~!~-~-QJ-~---- ._,?L~x J./.~ -----······----·-·-- PLAYERS Shirt Family Name ~-~------~Name -,-----,---- No. [PRINTED- BLOCJ< I [PRfNTEO- 8/_DCK LETTERS Hockey fndh1 !0 Cmr_l 1 - 3'2 L£TTEF<.Sj i No L 02. ------. /o·<><-·V· jq3$"~~- i 6"j ------'-ft\'4&WD . 11~Scp -('~Lf___ L_. • ~ ~s~-- -L____O_F : • J2 z f, 2:> j <>6 : • .f:.\ ! ;·:; -- . l~~L3 f, ~- ! of ' : ~,N&:L-,L ______p.ft> ~..,__r;,~f' o7-M- 9~ \-;:}_3~S. . 6"f___ .l_. __ .. -···---•:-j--SNA.SHt A.4J.A v;o.O{,.,;;;;;>$G;Zf """'-'!· · ;..__ • -t S'H'"""'""' s;;v T>~o~04-M/'! ?t-n.· 9~ I ( C.L =\q'3(;.S I1. II -·---·-- _ ~-::J ... AA~~ l?leo __.k-tYtiiW? /r-2.· 77 PIL'43_f,f; __ i /2- : ~ .--[_L G YL · Ot• j ,QtL/310 ~tc/t· '7.£ \_':}3 f,"}__ l,_.a___;_ __ u~HI!c&q ~~~ Sl>-::..14'1- 1 1 1£ j------1" tveV ;J!HiT I<.AU l>a • 'SF I /7 · • I v o ud J"li-r.... ___ •}ktt<~tY DEeP LsAvl! l>fa 4ckA< s:hNI ~lo 4-':." _ • . ,Z t_ _rp Dj_~_$_f!_!i_l'i..Sl'l5Jt.'2. >-o£· 7.3 I __ ___L-'l..:;; I Team Manager: t!J./"o.d!fj[_t"d?' T" lc..t;U£_ Coach: $1ftv ke.>Mt\7'( J"AtAII ,____ ---L:~';f5"------_ 1---.:t~:t£

~~TEAM COLOURS ALTERNATIVE COLOURS Shirt: oK~~c.,.~ Sh1rt. PIN~';. Sho,1s: (1,. Li'KJ<;:.. Shorts: p, (J:.<:.to... Socks: lll~c.tc.... Socks: e,~N.C.I!f' Go;~!kee-p~~

One set must comprise at least 80"/<:> single colour per piece. Goalkeeper shirt must comprise different colour to botll pr!mar,• and 3!tern~!e ::oto~~ of~'::i.r".:...... --- i 2--"' · o~t · 2.6/.J. ! N8~c· M. 111'-f/ftt!.,-r Et:T !c.Av~ Date:

P0~ition· 1-ta.clc.Gt CO.!le/-1 tfN"DU Signature: ,~~}--- 1~ ·-:~ot~?: !t is mandatory for the pclrticipiltifl9team to be in proper kii-\·7itli ·co-rre::c·t Shi"rti-l~'f~·ibers-arid'COiorS, faili119 which t.hey will be pen an zed. Also, it is mandatory for a team~ :r:n;;;;t~cks Ito avoid any color clash).

~~D~~dce~ Sin~- \ Joint Secretary (S) ..~.ssociation of Indian Universiti~:s ;"'..lU Housr::, 16, Indrajit Gupta i•t:.:rg, i·Je\',' De!h!-110002 L1J~td~ (JAj~~~~

~~ll:l Of (" 'J, & HOCKEY• INDIA \J. - Cf %J ~ 3 ~-~WM~001)! ENTRY FORM~~

~~COMPETITION: ...?.tf1 .. f:1.0.~.k-~Y.. .I!1.2i<>__~:~_Qi_c>r_\fl/_(l!l:l~l2.1':l.a_ti_c>T)_?J. Ch a 11']£l9.f!~f1_ipJ9.!.~JQiv__f:.L ......~~

~~DATE OF COMPETITION: ... ~!3.. .'\P..ril_:::§.. rv)CIY 2C 1.5. .. ST.~T~: __ QtO;in) __tj_o_c_~Y. ______...... -·-·------·------PLAYERS~~

~~Hockey India /D Card Father's Name No.~~

~~Team Manager: Co•ch: Singh 8860489152~~

TEAM COLOURS ALTERNATIVE COLOURS Shirt: Red/Black Shirt: Shorts: Red/Black Shorts: .3ocks: Clack Souks: Goalkeeper shirt: Parrot Goalkeeper shirt (Must comprise different colour to both primary and alternate colour (Must comprise different colour to both primary and alternate colour of shirt) of snirt) ,

~~One set must comprise at least 80% single co lou oalkeeper shirt must comprise different colour to both primary and alternate j co lour of shlrl~~

~~Name: Mahesh Dayal Date: 22to•'2'j±60 r ~ "I- •. •. ' . ~)-.~~~

~~~-J}4/9.;s_3 M- · ::>. 9 · e4 · MJ!i~~

~~HOCKEY- 1 NDI..; ENTRY FORM~~

~~COMPETITION: 5th Hockey India Senior Women National Championship 2015 (DivA)~~

~~DATE OF COMPETITION: 26th April to 3'd May STATE: HOCKEY 2015 ODISHA~~

~~PLAYERS~~

Shirt Family Name First Name Date of Birth Hockey India ID No. (PRINTED- [PRINTED- BLOCK Father's Name (ddlmmtyyyy) Card No. 1-32 BLOCK LETTERS] LETTERS] - 1 , TOPPO ARTI RESHMA C) !< AJIT KUMAR TOPPO 16.08.1998 fL /o~>':l/ oo1::r+/1 I 'I \ ':\3 Cf-::}- 3 • TOP PO t~~~~ PRABHAKAR TOPPO 23.05.1995 5 • SAHU ~yXJ\l~~ SUDHA DASARATH SAHU 15.03.1995

2 t EKKA JIRA BHAKTU EKKA 04.03.1995 \ ':i-"". o a 6 • EKKA ANITA BANDHU EKKA 28.12.1994 \1-\..\. 0\ DUNG DUNG PRITI MALA GEROG DUNG DUNG 08.04.1994 11· \1-l.\cn- GEORGEEKKA 7 • EKKA r){~~? 03.04.1997 Jdwt/'~= I !

~~------10 ~ EKI~~

TEAM COLOURS ALTERNATIVE COLOURS Shirt: ORANGE Shirt: SKY Shorts: ORANGE Shorts: ORANGE Socks: STRIPE YELLOW Socks: STRIPE YELLOW Goalkeeper shirt BLACK Goalkeeper shirt: YELLOW (Must comprise different colour to both primary and alternate (Must comprise different colour to both primary and alternate colour of shirt) colour of shirt) One set must comprise at least 80% single colour per piece. Goalkeeper shirt must comprise different colour to both primary and alternate colour of shirt.

~~Name: PRATAP SATPATHY, Date: 13.04.2015 ·. • .~~~

COMPETITION: --~th.I:1.2'*-~Y.J!l_d.i_rii_::: ___Q~ __ tv1_a.Y.. ~9_1_~--- STATE: ------·MAHARASHTRA . --· --- PLAYERS_ ------st.trt Family Name First Name Date of Birth Hockey India 10 Card No. {PRINTED- BLOCK {PRINTED - BLOCK Father's Name (ddlmm/yyyy) No. --.--11- 32 LETTERS] LETTERS DUBERKAR CHAIT ALl \1-'--111- SUNIL 19/02/1991 --,-1ii CHOUDHARI DEEP ALl~~ '-t\~ CHOTU 12/06/1995 fL-{M~I-~~OLC';\<,1 !10~ , 2 KHAN ALIYA (':1'-\\q SHAKEEL 27/07/1994 • 3 PATIL RUPALI t'1-'-l ~'D KASHINATH 06/04/1993 - ~ GAVAD APARNA [t;J-'-12.\ RAJSHEKHAR 30/11/1994 • 6 PAWAR SNEHA !':fl..\'2_.'2- GAJENDRA 28/04/1992 • 6 HARNE PRATIKSHA \•;) '-!2?. VILASRAO 21/01/1995 PUMAH/01584/2014 -- • 7 AHIRRAO MANJUSHA 11-'\'U SANJAY 22/10/1994 --- • 16 RATHOD CHAYA \'l_'-1'2.5 VASANT 12/05/1995 --;-9 --- WAKASE SNEHAL \'1-'{U POPATRAO 24/04/1998 • 17 INGALKAR GAYATRI \':1'-{z::l- VIJAY 06/07/1998 • 10 SAWANT PRATIBHA \':1-'i~ SRI KANT 02/11/1986 • 11 SHAIKH NIKHAT \'1'-\2. q_ JAMALUDDIN 27/07/1995 PUMAH/01585/2014 • 12 BHOYAR POOJA \':-J'--l_go SURESHRAO 20/07/1995 PUMAH/01582/2014 l---;-:t3 LA GALl SNEHAL \1~\ VIRUPRAKASH 12/12/1995 PUMAH/01580/201~ • 14 KALE JAGRUTI \':1-~2. CHANDRASHEKHAR 12/01/1994 -.15 GANGURDE SUPRIY A \'1 '-\ 3. KIRAN 16/11/1990 3 -- • 8 TIWARI SHRADHA \q~.Jg:'-J SANJAY 2.6/0971999

Team Manager:Shanon Stephen Picardo- 8898944140 Coach:Sonali Digambar Ganthade- 9766370931 \'-t"'--1 r ~ s r +'i :.sb TEAM COLOURS ALTERNATIVE COLOURS Shirt: Orange/ Black Shirt: Orange I Green Shorts: Black Shorts: Black Socks: Black Socks: Orange Goalkeeper shirt: Maroon Goalkeeper shirt: Maroon (Must comprise different colour to both primary and alternate (Must comprise different colour to both primary and alternate colour colour of shirt) of shirt)

~~One set must comprise at least 80% single colour per piece. Goalkeeper shirt must comprise different colour to both primarv and alternate colour of shirt.~~

Name: Manoj Bhore Date: 18 /04/2015 Position: General Secretary /$0!~ Signature: 7 mol-- Note: It is mandatory forth~ (;arli~-m fl be in proper kit with correct«! iA, ti.tl'?~ .'J d 'Ht'f ~which they will be penalized. Also, 1 is n: ~fa am to bring two sets of Soc~- o o nAA61'k, _ . ji\ffi_...- H N. GENE L SECR ARY ~ ..,.,_~~ HOCKEY MAHARASHTRJ\ &?e~veep cL~_) cld,,~,~

~~~. <;:' ~C\~u:;r:;J /~ ~ L) \~ t_.S'c-o/ ')..""\. ~.\S' ENTRY FORM~~

~~COM PETITION: 5th Hockev India Senior Women National Championship 2015 (Div_AL__~~

DATE OF COMPETITION: 26 April- 03 May 2015 STATE: /1//JfKffA_[, __ - ' PLAYERS ---- Shirt [ Family Name First Name · No. {PRINTED- BLOCK [PRINTED - BLOCK LETTERS Date of Birth Hockey India I[ Father's (ddlmmlyyyy) No. 1- 32 _,_ LETTERS] Name

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