Clone of Competition Entry Form

TEAM REGISTRATION

Competition & Banquet June 10, 2017
Company Information
Mine Name*
Company *
Contact Name*
E-mail*
Phone*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Team Registration (choose one)*

Mine Rescue Team3 Person First Aid TeamCombined (Mine Rescue + First Aid)

Mine Rescue Team List

3 Person First Aid Team List

Banquet Guest Registration

List FULL names of guests other than Registered Team Members who will be attending the banquet. Tickets $60.00 each. Send requests for additional tickets to Lori.Wade@gov.bc.ca
Guest List Names
Total Banquet Tickets:

T Shirts for Team*

# of Lunches Needed for Team*
Lunch provided for team members, captain, coach and manager. Please email any dietary restrictions/allergies/concerns to Lori.Wade@gov.bc.ca
NOTE:
- Banquet Tickets will be available for pick up along with team t-shirts/bags at Kimberley Conference Centre Friday afternoon
- Allowable free tickets for registered teams are as follows: Manager & Coaches 3, MR Team & Spare 7, Three Person FA Team 4
- For banquet catering purposes REGISTER BEFORE April 28th, 2017
- CANCELLATION POLICY: There will be no refunds after April 28th, 2017
Cocktails served at 6:30 pm -

Prime Rib Dinner served at 7:00 pm
If you have a technical question regarding this form or need any assistance please contact Lori Wade @ 250-417-6134
Admin Fee*
Banquet Tickets + Admin Fee =
Should be Empty:

TEAM REGISTRATION