Phil Open Qualifier Entry Form

PHILIPPINE OPEN POOL CHAMPIONSHIPS
Qualifiers: March 31 to April 4, 2011
Main Tournament APRIL 7-11, 2011

QUALIFIER ENTRY FORM

Single event entry: $50 Five events: $200

Name(required)

Country

Address(required)

Email(required)

Telephone(required)

New Field(required)

Select Number of Qualifiers you wish to join and amount to be paid:

Maximum 5 Quialifiers (US$200.00 Discounted rate)

Less than 5 Qualifiers (US$50.00 per Qualifier)

Total Qualifiers (below 5)

Total Amount(required)

Schedule of Qualifiers — please select only ONE per day:

Day 1 March 31, Thursday

Qualifier 1 (9:00 am)

Qualifier 2 (1:30 pm)

Day 2 April 1, Friday

Qualifier 3 (9:00 am)

Qualifier 4 (1:30 pm)

Day 3 April 2, Saturday

Qualifier 5 (9:00 am)

Qualifier 6 (1:30 pm)

Day 4 April 3, Sunday

Qualifier 7 (9:00 am)

Qualifier 8 (1:30 pm)

Day 5 April 4, Monday

Qualifier 9 (9:00 am)

Qualifier 10 (1:30 pm)

Deadline for Registration: 10 March 2011
Payments should be made in cash or bank transfer by 15 March 2011 to
Raya Sports/ PRISM Office,
5/F, PDAF Bldg., Sen. Gil Puyat Avenue, Makati City 1200 Philippines.
For bank transfer see details below.

Account Name: PRISM, Inc. (Policy Research Information Strategy & Media Services Inc.)
Bank: Banco de OroAccount No. 2780043993
Branch: Paseo Gil Puyat BranchAddress: Paseo corner Gil Puyat Avenue, Makati City
Swift Code: BNORPHMM

Please fill up the entry form above or click here to download the PDF file and send it with a Certification from your nationalassociation/federation by fax to +63(2) 8909666 or e-mail to raya@prismphil.com not later than 10 March 2011.