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Competition Entry Form


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Sat 25 March 2017
Prize Fund £TBA - Entry Fee £20.00
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Venue: Players Lounge,
10 Queens Road,
Newcastle-Under-Lyme, Stoke-on-Trent,
Staffordshire, ST5  1RW
Tel: 01782 660246

Tournament Director: Alan Benton

*** CLOSED ***
Closing Date for Entries: 22.03.2017

ENTRY FORM (Order Reference - FC1AC6F1)

Primary Contact/Entrant Details
First Name * Required Field
Last Name * Required Field
Address1 * Required Field
Town * Required Field
County * Required Field
Postcode * Required Field
Telephone * Required Field
Alternative Phone
e-mail * Required Field
EPA Id No * Required Field
Date of Birth
Verify thisWhat does this say? * Required Field

By clicking "Submit" you are agreeing to the entry terms for this competition
(available elsewhere on this web site)
Note - your on-line entry will only be accepted when you have paid

You do NOT need a PayPal account to pay using PayPal


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