Application FormName: Email Address: Postal Address: LAS membership number (If applicable):

Which qualifier(s) would you like to enter? 12345678Exeter Canal, 6th April 2014 Kennet and Avon Canal, 13th April 2014 Grand Union Canal (Midlands), 11th May 2014 River Thames, Oxford 5th July 2014 Regents Canal 6th September 2014 Stainforth and Keadby Canal 13th September 2014 Leeds Liverpool canal 14th September 2014 Ferry Meadows 21st September 2014

Please list which qualifier(s) that you wish to attend:

All qualifying matches cost 25 (20 for LAS members) to enter which includes your day ticket. Please insert here the total cost of your application: . p

Please indicate which payment method you are using: Payment can be made by paypal to lurematch@gmail.com or by cheque made out to Mr Julian Chidgey. Address BLAC 2014, 3 Chapel Hill, Uffculme, Devon, EX15 3AD. Upon receipt of payment you will be supplied with a full list of the rules as well as maps for the event (s) you have entered.