2017 Victorian Senior State Team - Player Application Form
The 2017 Australian Lacrosse Association Senior National Championship will be held in Adelaide from June 8 - 11.

Eligibility: Registered member of an affiliated Lacrosse Victoria Inc. club, financial with Lacrosse Victoria and their club.

Players who do not submit the application form before the closing date will not be eligible to trial.

All applicants will be advised of the trial dates, times and venues once set by the coach.

The closing date for player applications is 29/3/2017.

Email address *
First Name: *
Your answer
Surname: *
Your answer
Gender: *
Date of Birth: *
Street Address: *
Your answer
Suburb: *
Your answer
Post Code: *
Your answer
Club: *
Playing Position: *
Your answer
Private Health Cover: *
A copy of your responses will be emailed to the address you provided.
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