National Welding Competition - Online Entry Form

County / Region:

Participating Branch / Club Name: *

Was a county round held for this competition?

		Yes
		No

If yes, how many entries?

This form is only to be submitted by a County Officer
I, the undersigned, certify that the person named below has qualified and is eligible in every respect to represent this county in future rounds of the National Welding competition, and that the information submitted in this form is correct.

County Officer Name: *

County Signature Code: *

County Officer Address: *

County Officer Tel. No: *

County Officer Email:

Method of Payment

Have you had a county round for this competition? If yes, please check box.

If there was a county round, how many entries were there?

All correspondence regarding this competition will be sent to the competitor.

Name: *

Membership No: *

Address: *

Tel. No: *

Email:

Mobile for Texting *

* = Input is required