Entry Form
New Zealand Orienteering Championships 2015
Closing Date for Entries and Payment Friday 6th March 2015
Last Date for Entries and Paymet Friday 13th March 2015
Online Banking (ASB) 12-3052-0311680-00
Cheques payable to : Counties Manukau Orienteering Club
Entry Fees
Senior
Senior 65 and over
Junior(<20yrs)
Junior(<12yrs)
Family ( 2 seniors + Juniors)
Surname
eg Smith
First Name
Fred
Sprint
20
15
10
5
50
Middle
40
30
20
10
100
Sport Ident
987654/Hire
Long
40
30
20
10
100
3rd - 6th April 2015
Post Entries to
Unni Lewis
58 Pah Rd Howick
Auckland 2014
Relay
20
15
10
5
50
All 4 days
110
80
55
25
275
Dinner
30
30
30
15
Club
CM
YOB
1975
Sprint
M40
[email protected]
www.cmoc.co.nz
Middle
M40A
Refunds for withdrawals at CMOC Committee's discretion
Sport Ident Hire: Add $3 per day per person if applcable but free for age 10 and under
ONZ LEVY: If not a club or IOF Member then add (per event) $9 per Senior, $5.50 per Juior, or $23.50 per family
LATE FEE : Add 50% for entries or payment received after 6th March 2015
DINNER : If you are staying at Wesley College for accommodaton and/or meals a separate form is available
Contact Name
Postal Address
Email
Phone
Parent Split Time Request
Payment Detail Method
Online Banking/Cheque
Long
M40A
Relay
ML3
Sub Total
SI Hire
ONZ Levy
Late Fee
Dinner
Grand Total
Dinner
YES
Total $
$
Accommodation
New Zealand Orienteering Championships 2015
Closing Date forAccommodation and Payment Friday 6th March 2015
Last Date for Entries and Paymet Friday 13th March 2015
Online Banking (ASB) 12-3052-0311680-00
Cheques payable to : Counties Manukau Orienteering Club
Accommodation/Meals
Adult
Junior(<12yrs)
Child <5yrs
Surname
First Name
eg Smith
Fred
Friday
Dinner
$18
$10
free
Post Payment to
Unni Lewis
58 Pah Rd Howick
Auckland 2014
[email protected]
www.cmoc.co.nz
Saturday Saturday
Br/Lunch Dinner
$20
$18
$12
$10
free
free
Sunday
Sunday
Br/Lunch Dinner
$20
$30
$12
$15
free
free
Monday Dorm
Br/Lunch
$20
$30pn
$12
$15pn
free
free
Camping
Accommodation
Dorm
Camping
Dorm
Age
Friday
Adult/Jun/CDinner
Jun
yes
Saturday Saturday
Br/Lunch Dinner
yes
no
Sunday
Sunday
Br/Lunch Dinner
yes
yes
Refunds for withdrawals at CMOC Committee's discretion
Continental breakfast, Make your own lunch from food provided
Bedding required yes/no
For overseas or Sth Is competitors only
Contact Name
Postal Address
Email
Online Banking/Cheque
$10pn
$5pn
free
Monday Total Amt
Br/Lunch
no
$
Total Accommodation/Meal
Please list children under 5 for security reasons
Payment Detail Method
3rd - 6th April 2015
Phone
Payment Detail