Date of birth 
 

   dd.mm.yy

Events Entered

. 1 MENS 40 SINGLES $20 2 MENS 50 SINGLES $20 3 MENS 60 SINGLES $20 4 MENS 70 SINGLES $20 5 LADIES 40 SINGLES $20 6 MENS 35 DOUBLES $16 ea 7 MENS 45 DOUBLES $16 ea 8 MENS 55 DOUBLES $16 ea 9 MENS 65 DOUBLES $16 ea 10 MENS 75 DOUBLES $16 ea 11 LADIES 35 DOUBLES $16 ea 12 LADIES 45 DOUBLES $16 ea 13 LADIES 55 DOUBLES $16 ea 14 LADIES 65 DOUBLES $16 ea

Partner.................

Player History

For seeding purposes, please list below details of your relevant record of play including wins and losses for the last 12 months. Kindly include the name of your opponent in each case. Include your current world and national ranking if applicable

Player Release

Player Agreement & Release

In consideration of your agreement to allow me to participate in the Brisbane Seniors Clay Court Tournament at Ernest St, Leichard, Ipswich in 2011 (“The Event”), I hereby agree as a condition of participation in the Event, to waive, for myself, my executors, administrators, heirs, and personal representatives, all claims of any kind, nature and descriptions including past, present or future, including any claims in respect of injuries sustained in travelling to, from, or participating in the Event against,Brisbane Seniors Tennis Club, Tennis Seniors Queensland Inc., Tennis Seniors Australia, Tennis Queensland, Tennis Australia or participating Tennis Clubs.

I confirm I have read the above Terms, Rules and Conditions and agree to abide and be bound by them together with the conditions of entry provided within the pdf form via the link above.

Type  I agree in the text box below to acknowledge your acceptance of the player agreement & release above.

Additional Fees*



 

Payment Method

Total Entry Fee


 

$0.00 - I am a registered Tennis Seniors member (Please quote your number * above) $30.00 TQ My Tennis fees for all Qld resident players (condition 3) $15.00 TSQ fees for all Qld resident tournament players (condition 4) $45.00 TSQ and TQ My Tennis fees for Qld resident players $45.00 $15.00 Temporary Fee for interstate/overseas non Seniors members for this tournament (condition 5) ONLY

If paying your $15 Tennis Seniors Membership Fee above please nominate
which club you wish your membership to be credited to here >

  Visa     Mastercard     Paypal     Cheque      Direct Deposit

Visa, Mastercard or Paypal payments to be made below with the Pay Fees button.
Cheques payments to be posted to the Tournament Secretary.