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Open Women State Teams Nomination Form - 2019
The Open Women National Championships will be held in Mirrabooka, WA in January, 2019 (dates to be confirmed)
**If you are nominating for the first time please ensure to submit a copy of your birth certificate via email sdom@softballwa.org.au**

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Nominee Information
First Name *
Your answer
Surname *
Your answer
Street Address *
Your answer
Suburb *
Your answer
Post Code *
Your answer
Date of Birth *
Your answer
Phone (Mobile) *
Your answer
Email *
Your answer
Emergency Contact
Full Name: *
Your answer
Mobile Phone Number *
Your answer
Relationship to Participant *
Your answer
Playing Positions
Please select your preferred playing position below (1/3) *
Preferred playing position - 2nd Preference (2/3) *
Preferred playing position - 3rd Preference (3/3) *
Additional Details
Name of Current Affiliated Club/s *
Your answer
Name of Association *
Your answer
Are you an Australia Citizen *
Name of Parent/Guardian
MANDATORY FOR ATHLETES UNDER 18 YEARS OF AGE. {Type N/A if over 18}
Your answer
Parent/Guardian Email
MANDATORY FOR ATHLETES UNDER 18 YEARS OF AGE. {Type N/A if over 18}
Your answer
Confirm Parent/Guardian Email
MANDATORY FOR ATHLETES UNDER 18 YEARS OF AGE {Type N/A if over 18}
Your answer
Medical Information
Does the participant suffer any of the following? *
Please tick all that apply
Required
Medical Information *
If you suffer from any of the above please provide details here. {Type N/A if you have no medical information to declare}
Your answer
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