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February 23, 2012
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Dynamic Registration
Team Leader Details
First Name *:
Last Name *:
Email Address *:
Address Line1:
Address Line 2:
City *:
Region:
Country *:
Afghanistan
Albania
Algeria
American Samoa
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Antarctica
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Argentina
Armenia
Aruba
Australia
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Belize
Benin
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Bolivia
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Bouvet Island
Brazil
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Burkina Faso
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Canada
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Central African Republic
Chad
Chile
China
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Cocos
Colombia
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Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
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Dominican Republic
East Timor
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Ethiopia
Falkland Islands
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Fiji
Finland
France
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Gabon
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Hong Kong
Hungary
Iceland
India
Indonesia
Iran
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Israel
Italy
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Jamaica
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Jordan
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Kenya
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Laos
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Liberia
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Mali
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Niger
Nigeria
Niue
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North Korea
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Norway
Oman
Pakistan
Palau
Panama
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Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
S. Georgia and S. Sandwich Islands
Saint Kitts and Nevis
Saint Lucia
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Samoa
San Marino
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Senegal
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Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Soviet Union
Spain
Sri Lanka
St. Helena
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Sudan
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Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
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Tunisia
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US Minor Outlying Islands
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Uzbekistan
Vanuatu
Venezuela
Viet Nam
Wallis and Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Postal Code:
Telephone:
Team Details
Team Name *:
Team Address:
Web Site:
Team Category:
Mens
Womens
Mixed
Mixed teams require a minimum of 3 women per team.
Age Group:
Mens 35+
Mens 40+
Mens 50+
Womens 30+
Womens 40+
Mixed
Team playing level:
Social
Competitive
Semi-competitive
Once were competitive
Estimated Team Numbers:
Players:
Supporters:
Accommodation preference - please choose one hotel and indicate how many of each room type your team would like to book.
Promenade Hotel
Share Twin/Double:
Triple:
Dazzler-Libertad Hotel
Share Twin/Double:
Triple:
Aspen Tower Hotel
Share Twin/Double:
Triple:
Entry Type:
Team / Group
Individual
Registration Fee :
Per team/group of US$200. If entering as an individual US$30
Entry fees refundable, less an admistration fee of US$50, and must be advised in writing prior to June 30th, 2013.
Bank Transfer
Cheque or Bank Draft
Credit Card (PayPal)
Terms and conditions *:
I have read and agreed on
Terms & Conditions
of entry
Register
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