Name: ……………………………………………………       Date of birth: ………………       

Club: ………………………………………………………      BFA number: ………………

Age group: Cadet / Junior / Senior / Veteran

Telephone number: ……………………………………

Address: ……………………………………………………………………. Postcode: ………

E-mail address: ………………………………………………………………………………

Emergency contact name and telephone number: …………………………………………………………………………………………………………

I accept that the organisers cannot be held responsible for any accident, loss or damage sustained at the tournament.

Signed: ……………………………………………             Date: ………………………

(Parent/Guardian if under 18)

Please post your entry form with the entry fee to Salle Ursa Fencing Club, 45 Limbrick Avenue, Coventry, CV4 9EX. Please make cheques or postal orders payable to Salle Ursa Fencing Club.