Queensland Beach Volleyball Tour Sandstorm Summer Smash When: Where: Divisions: Entry Fee: SATURDAY, 10 JANUARY 2015 Sandstorm Sports, 590 Mains Rd, Nathan Mt Gravatt AAA men/women; AA men/women;; Junior men/women $55 per team All participants must be VQ Registered You will not be included in the tournament draw until your entry form and payment are received and you have renewed your VQ registration (completed form and payment). ENTRIES DUE MONDAY, 05 JANUARY 2015 PREFERRED DIVISION* (please circle): AAA/AA/Junior Men/Women Player 1:: __________________________________ Player 2:: ______________________________ __________________________________ Mobile: ___________________________________ ________________________________ Mobile: ________________________________ ___________________________________ Email: __________________________________ __________________ Email: __________________________________ ____________________________________ D.O.B:: ___________________________________ ________________________________ D.O.B:: __________________________________ ________________________________ VQ ID (if known): ___________________________ _________________________ VQ ID (if known): ___________________________ _________________________ *VQ will do its best to accommodate this preference but cannot guarantee this will be the division players are assigned to. PAYMENT Money direct debited to Volleyball Queensland Bank Account on __/ __/ 201 2014 Account Details: BSB 124 001 (Bank of Queensland) Account Number: 20329775 Please reference the deposit with the title “Athlete’s Name and Summer Smash” If you choose this option you must email your remittance advice to [email protected] before entries close. Please debit my Visa / MasterCard for $__________ Card Number: __/ __/ __/ __ __/ __/ __/ __ __/ __/ __/ __ __/ __/ __/ __ Name on Card: ______________________________________ Expiry Date: __/ __ Signature: __________________________________________ _____________________________ CVV: ___________ Please send your entry form to [email protected],, or fax 3367 2853, or phone VQ on 3367 1991.