*Team Contact

*Team Contact Email
Event Information will be sent to this e-mail address

*Company

*Address

*Phone

Company Contact

Company Contact Email

*Team Name

*Team Category Mixed (min. 2 women on team) Male Female

*Playing Time - Choose 1st to 3rd Preference:
12:05pm

*12:45pm

*1:25pm

*Location/Day Pot Black, 106 James Street Northbridge. - Wednesday

*Team Member 1

*Team Member 2

*Team Member 3

*Team Member 4

Team Member 5

Team Member 6

*COST: Eightball Pool $150.
Please note that team entries will only be confirmed on receipt of payment.
Cheques are to be made payable to Integral Health and Fitness and can be
mailed to: Integral Health and Fitness PO Box 663 Hillarys WA 6923 - OR.... Direct Credit to our Account: E-mail for our Account Details. Credit Card (Visa or Mastercard). Phone 9402 5303 to pay by Credit Card.

*CONDITIONS OF ENTRY: All participants should note: It is the responsibility
of each participant to ensure they are physically and medically fit to
participate in the Corporate Challenge.
It is, in the consideration of and as a condition of acceptance of any entry in the
Corporate Challenge events for each person, their heirs, executors, administrators
and employers hereby waive all and any claim, right of cause of action which they
might otherwise have for arising out of loss of life, injury, damage or loss of any
description whatsoever which may be suffered or sustained in the course of or
consequent upon the persons entry or participation in the event.
This waiver, release and discharge shall be and operate separately in favour of all
persons, corporations and bodies involved or otherwise engaged in promoting
or staging the event and the servants, agents, representatives and officers of any
of them.
Team entries will only be confirmed on receipt of entry form together with payment.
Event rules, fixtures and information will be sent on receipt of entry form.
Have FUN, play safely within the rules and within your own physical capabilities.
ALL TEAM MEMBERS HAVE READ THESE CONDITONS OF ENTRY AND
AGREE WITH THEM.

*Required