Name of Event Partners Name Fees

2021 Tennis Seniors Queensland Membership Fee - $20.00 (Refer Regulation 3)

Please nominate which Seniors Club you wish your membership to be credited to: ___________________________________________________________________________

SPECIAL CONDITION: Tournament Levy for this tournament only $10.00 (Refer to Regulation 4 – for financial members of club conducting tournament, interstate or overseas players ONLY)

Total Amount Enclosed

Entry Fees: Singles $25.00 Doubles $20.00 per player

PLAYER DECLARATION: I certify that I am a registered member of

__________________________________________________ I acknowledge that as a participant in the Murgon Seniors Tournament I am required to comply with various rules, regulations and policies as listed in the attached Tournament Regulations.

Signature:_____________________________________________________Date: _____________________

__________________________________________________________________________ Office Use: Amount Rec’d $ Date Rec’d Receipt No.

__________________________________________________________________________

ENTRIES CLOSE: __________ Cheques payable to:_______________________________ orDirect Deposit: ___________________________________Save and Send entries to: __________________Add: _____________________________Email to : ________________________________

2021 MURGON SENIORS TOURNAMENT

Surname: ___________________ First Name: ___________________ Male Female Postal Address: ________________________________________________ D.O.B: _______________ Suburb: _________________________ State: _____ P/Code: _____ Mobile Phone: ______________ Email: _____________________________________________________________________________ I am a member of ___________________________________________________________________ MyTennis ID: ____________________________ 2021 Tennis Seniors Rego. No: _________________ Tennis Seniors Aust. Ranking (Singles) ____ (Doubles)____

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Payment Ref:Your Name (DZelinski)

Session

Saturday Night BBQ Dinner and Dessert $20.00

Sunday Morning All You Can Eat Brekkie $10.00