Ebass Entry Form

    Team Name

    Skipper

     

    Name

    Phone Number

    Email

    Street name and number

    Suburb

    Town

    Postal Code

    Co-Angler

     

    Name

    Phone Number

    Email

    Street name and number

    Suburb

    Town

    Postal Code

    Reserve Angler

     

    Reserve angler Name

    Reserve angler Email

    Skipper Banking Details

     

    Bank Name

    Bank Account Holder

    Bank Account Number

    Branch Code

     

     


    I hereby confirm that I have read and understand the Indemnity(Details on this website). I further agree to subject myself to the terms and conditions set out there in.