Summer Comp 2019 - Senior - Wednesday
Nomination Fees to be paid in advance to TBHA. Use your surname as reference. BSB: 082 738 Account No. 69 812 9497
Juniors $50, Seniors $70
First Name *
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Last Name *
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Date of Birth *
MM
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DD
/
YYYY
Email Address *
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Mobile Phone Number *
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Emergency Contact *
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Emergency Contact Mobile Number *
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Team Name (if you have one otherwise you will be placed in a team)
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Team Contact Name
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Hockey Club
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Preferred Position 1
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Preferred Position 2
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