M A R D E L P L ATA
ARGENTINA
21- 2 8 S E P T E M B E R
2 0 14
MAR DEL PLATA, ARGENTINA 21 - 28 September 2014
AY 8D T / FROM H IG S 7 N KAG E 99 1 C 1 A P S$ rson*
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www.goldenoldiessports.com
M A R D E L P L ATA
ARGENTINA
21- 2 8 S E P T E M B E R
2 0 14
Entry Form Golden Oldies World Rugby Festival Please accept the following entry to the 2014 Golden Oldies World Rugby Festival to be held in Mar Del Plata, Argentina, from 21–28 September 2014. Team Manager
Title
First Name
Surname
Address
Street
Street No.
Suburb
City
Business
Home
Country Phone Fax Email Team Name Male
Total number in group
Female
Total
Entry Fee US$150.00 per team non refundable Credit Card
q Visa q Mastercard q Diners q AMEX
Charges: Visa/Mastercard 2.4% and AMEX/Diners 3.95% Credit Card No. Name on card Expiry date
Date
Signature Amount to be charged
Please Note: All payments must be in United States Dollars, (USD). Entries close 21 July, 2014. Direct Bank Transfer: If you wish to direct-transfer the Entry fee our bank account details are as follows: ASB Bank Limited, 135 Albert Street, Auckland 1010, New Zealand Account Number: 26840783-USD-23 Swift Code: ASBBNZ2A Account Name: Golden Oldies Sports Limited Entry Fee: USD$150.00 per playing team Post to: Golden Oldies Sports Limited, P.O Box 331 469, Takapuna 0740 Auckland, New Zealand