Welcome to Ashton Conker Club

ACC REFERENCE or NEW PLAYER

Have you played before?

No Yes

If YES, ACC Reference

PERSONAL DETAILS

Surname

First name(s)

Preferred name

Title

Choose One Mr Mrs Miss Ms Dr Rev

Date of Birth

Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Nationality

Select from List Afghan Albanian Algerian American Andorran Angolan Antiguans Argentinean Armenian Australian Austrian Azerbaijani Bahamian Bahraini Bangladeshi Barbadian Barbudans Batswana Belarusian Belgian Belizean Beninese Bhutanese Bolivian Bosnian Brazilian British British (English) British (NI) British (Scottish) British (Welsh) Bruneian Bulgarian Burkinabe Burmese Burundian Cambodian Cameroonian Canadian Cape Verdean Central African Chadian Chilean Chinese Colombian Comoran Congolese Costa Rican Croatian Cuban Cypriot Czech Danish Djibouti Dominican Dutch East Timorese Ecuadorean Egyptian Emirian English Equatorial Guinean Eritrean Estonian Ethiopian Fijian Filipino Finnish French Gabonese Gambian Georgian German Ghanaian Greek Grenadian Guatemalan Guinea-Bissauan Guinean Guyanese Haitian Herzegovinian Honduran Hungarian I-Kiribati Icelander Indian Indonesian Iranian Iraqi Irish Israeli Italian Ivorian Jamaican Japanese Jordanian Kazakhstani Kenyan Kittian and Nevisian Kuwaiti Kyrgyz Laotian Latvian Lebanese Liberian Libyan Liechtensteiner Lithuanian Luxembourger Macedonian Malagasy Malawian Malaysian Maldivan Malian Maltese Marshallese Mauritanian Mauritian Mexican Micronesian Moldovan Monacan Mongolian Moroccan Mosotho Motswana Mozambican Namibian Nauruan Nepalese Netherlander New Zealander Ni-Vanuatu Nicaraguan Nigerien North Korean Northern Irish Norwegian Omani Pakistani Palauan Panamanian Papua New Guinean Paraguayan Peruvian Polish Portuguese Qatari Romanian Russian Rwandan Saint Lucian Salvadoran Samoan San Marinese Sao Tomean Saudi Scottish Senegalese Serbian Seychellois Sierra Leonean Singaporean Slovenian Solomon Islander Somali South African South Korean Spanish Sri Lankan Sudanese Surinamer Swazi Swedish Swiss Syrian Taiwanese Tajik Tanzanian Thai Togolese Tongan Trinidadian or Tobagonian Tunisian Turkish Tuvaluan Ugandan Ukrainian Uruguayan Uzbekistani Venezuelan Vietnamese Welsh Yemenite Zambian Zimbabwean Please enter your Nationality

Town/Place of Birth

Occupation

Email

Confirm Email

HOME ADDRESS
You must provide a VALID POSTAL ADDRESS so that we can post your entry documents. “Care of” or “c/o” addresses are not allowed and may be rejected.

House/Street

Area/District

Town/City

County/State

Country

Postal/Zip Code

TELEPHONE CONTACT DETAILS
Please supply all details in case we need to contact you with a query

Home Phone

Daytime Phone

Mobile/Cell Phone

TEAM DETAILS
Please help by returning ALL team entries in one envelope. Thank you.

Team Name

Are you the Team Captain?

No Yes N/A

Note: Team entries will be mailed to the team captain. If you wish to have entries mailed to individual team members please select YES here.

Mail entries individually?

Yes No

PUBLICITY

Please exclude me from pre-event publicity

Yes No

FUND RAISING INFORMATION
Please remember that obtaining sponsorship increases the amount we can donate!

Please send me a sponsorship form with my confirmation:

Yes No

RESERVE PLACES
We will call on reserves on the day if other competitors fail to turn up. Note: if you select YES but you are NOT CALLED TO PLAY then your entry fee is NOT REFUNDED.

If all places have been filled do you wish to go on the reserve list?

Yes No

Click this button to review your completed entry form. Your entry form will be displayed in PDF format in your browser window. Click “Print” then post it to us together with your entry fees. We can only accept postal entries accompanied with an entry fee. Entries by email will not be accepted.

Problem? If your entry form doesn’t display or print properly, press the BACK button in your browser, change the Form Display Format from PDF to HTML (below) then click the large button again.