Sandstorm Smash Nominations - Queensland Volleyball Association

Queensland Beach Volleyball Tour
Sandstorm Summer Smash
When:
Where:
Divisions:
Entry Fee:
SATURDAY, 10 JANUARY 2015
Sandstorm Sports, 590 Mains Rd, Nathan Mt Gravatt
AAA men/women; AA men/women;; Junior men/women
$55 per team
All participants must be VQ Registered
You will not be included in the tournament draw until your entry form and payment are received and you
have renewed your VQ registration (completed form and payment).
ENTRIES DUE MONDAY, 05 JANUARY 2015
PREFERRED DIVISION* (please circle): AAA/AA/Junior
Men/Women
Player 1:: __________________________________
Player 2:: ______________________________
__________________________________
Mobile: ___________________________________
________________________________
Mobile: ________________________________
___________________________________
Email: __________________________________
__________________
Email: __________________________________
____________________________________
D.O.B:: ___________________________________
________________________________
D.O.B:: __________________________________
________________________________
VQ ID (if known): ___________________________
_________________________
VQ ID (if known): ___________________________
_________________________
*VQ will do its best to accommodate this preference but cannot guarantee this will be the division players are assigned to.
PAYMENT
Money direct debited to Volleyball Queensland Bank Account on __/ __/ 201
2014
Account Details: BSB 124 001 (Bank of Queensland)
Account Number: 20329775
Please reference the deposit with the title “Athlete’s Name and Summer Smash”
If you choose this option you must email your remittance advice to [email protected] before entries close.
Please debit my
Visa / MasterCard for $__________
Card Number: __/ __/ __/ __
__/ __/ __/ __
__/ __/ __/ __
__/ __/ __/ __
Name on Card: ______________________________________ Expiry Date: __/ __
Signature: __________________________________________
_____________________________
CVV: ___________
Please send your entry form to [email protected],, or fax 3367 2853, or phone VQ on 3367 1991.