Monthly Game Prize Winners

Your Name (required)

Your Surname (required)

Your Email (required)

Message (required)

Your Name (required)

Your Surname (required)

Your Email (required)

Will you be able to play in this meeting? (required)
YesNo

If you selected "No" above - Do you require leave of absence? (*Compulsory)
YesNo

(Authorised leave of absence counts towards game playing commitment but not Nationals Qualification)
Reason for leave of absence:

Payment Option
EFT (reference to be your name & club we are playing at)Cheque / CashPrepaid (upfront)Not Applicable

Will you bring a visitor?
YesNo

If yes, please fill in the form below:
Visitors Name (required)

Club Name(required)

H/C (required)