Name of Team: ..................................................................................................................................................... ..................

Company Name (if applicable): .............................................................................................................................. ..............

Contact Email Address for Team: ......................................................................................... ..............................................

Team Members:
(You may have between 5 and 8 players in your team to allow for subs, however all games are played as 5-a-side)


Name Address D.O.B Disabled?
1
2
3
4
5
6
7
8

Team Entry Fee = 50.00 (Entry fee is 50 per team, regardless of the number of players)

As a team you are invited to join in a free short training session with CBWA before the event, between 10.30am and
11.00am, if you are not attending this please arrive by 10.50am. Specially designed sports wheelchairs will be provided on
the day. The team may come in fancy dress, uniform, or normal casual clothing, coloured sports bibs will be provided on
the day if required. Please wear suitable footwear so that we do not cause damage to gym flooring.

Optional: If you wish to purchase t-shirts with your company/team logo on please state below how many of each size you
require below, there is a 4.00 charge per t-shirt, of which all of the profit will go to our nominated charities. Company
logos must be emailed to leannebeverley@hotmail.co.uk by 23
rd
August 2014 and be no larger than A5 size. These will
be sent to you prior to the event, please specify address on email.

Small Medium Large X-Large


Please fill out the above information and return with a cheque for the total amount
(50 team entry fee + t-shirt fee if applicable) made payable to:
Rotary Club of Coventry Jubilee
by post to: Leanne Beverley, 76 Keresley road, Keresley, Coventry. CV6 2JD.
Please submit registration by 15
th
August 2014, teams will be registered on a first come first serve basis
For more event information visit www.rotarybasketball.weebly.com
This event is organised by the Rotary Club of Coventry Jubilee and will take place on September 14
th
2014 at Woodlands Academy, Broad Lane. The
tournament is open to anyone, of all abilities, age 9+. We hope to get a variety of able bodied, disabled and mixed ability team from both businesses
and the general public. All proceeds from the event will be split between Coventry Wheelchair Basketball Academy (part of YMCA) and Rotary
charities.
Sunday Sept 14
th
2014 11am-3pm
Woodlands Academy, Broad Lane
Team Registration Form
T-Shirt Fee (if applicable): 4.00 X .......... = ...... .00