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2014 State Teams - Trial Registration Form
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* Indicates required question
Player's Personal Details
Must be completed by the player
First Name
*
Player's First Name
Your answer
Last Name
*
Player's Last Name
Your answer
I am trialing for:
*
Please select the team from list
Choose
U16 Boys North
U16 Girls North
U16 Boys South
U16 Girls South
U18 Boys North
U18 Girls North
U18 Boys South
U18 Girls South
U20 Mens
U20 Ladies
I will attend trials at:
*
Please select where you will be attending trials
Choose
North
Central
South
Playing Position
*
Your answer
D.O.B.
*
DD/MM/YY
Your answer
Residential Address
*
Street, Suburb, Postcode
Your answer
Player's Email Address
*
Your answer
Home Phone Number
*
Your answer
Mobile Phone Number
*
Your answer
Height
*
cms
Your answer
Weight
*
kgs
Your answer
Association
*
Your answer
Are you and Australian citizen?
*
Yes
No
Do you hold Dual Citizenship?
*
Yes
No
If you hold Dual Citizenship, please nominate country below
Your answer
Do you identify yourself as an Aboriginal or Torres Strait Islander?
*
Yes
No
Do you have any medical conditions?
*
Yes
No
If you answered YES to the above question, please state briefly:
Your answer
Do you have any allergies?
*
Yes
No
If you answered YES to the above question, please state briefly:
Your answer
Parent/Guardian Details
Must be completed by the player
Parent/Guardian First Name
*
Your answer
Parent/Guardian Last Name
*
Your answer
Parent/Guardian Email Address
*
Your answer
Business Phone Number
Your answer
Home Phone Number
Your answer
Mum's Mobile Number
Your answer
Dad's Mobile Number
Your answer
By completing this form I accept all conditions and payments in regards to the State Teams Squad Trials/Camps.
*
I Accept
Required
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