England Junior Squad - 2016 Mixed 15s Expression of Interest

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If you are interested in being considered for the England Mixed 15s development squad for 2016, please provide us with the details below.

First Name *

Last Name *

Gender *

Male

Female

Date Of Birth *

Tournament rules: participants must not have turned 15 until 01/01/2016; the lower age is set at 13, meaning that a participant must already be 13 at 31/12/2015* (*Note: there is a process for exemption for the lower age criteria)

YYYY

Player's contact email address (if applicable - otherwise please enter NA) *

Player's contact phone number (if applicable - otherwise please enter NA) *

i.e. 07777 123456 (please use a space after the first 5 digits)

Parent/guardian contact email address *

Parent/guardian contact phone number *

i.e. 07777 123456 (please use a space after the first 5 digits)

Are you and England Touch member? *

If you are not already a member, you need to have a current individual player membership: http://www.insure4sport.co.uk/eta/individuals.aspx

Yes

What is your ETA Membership number? *

Put 'TBC' if you are in the process of obtaining membership

Which of the following applies to the player? *

Please provide nationality and commencement of residency if 'other' applies

British citizen (passport)

British citizen (birth but no passport)

Residency (2 Years) with ancestry visa

Residency (3 Years) with valid visa

Other:

Please provide details of Touch club and other playing/sport experience

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