REGISTRATION FOR NORTHERN YOUTH DEVELOPMENT DAY & U19 TRIALS

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First Name *

Last Name *

Email Address *

Please provide a valid email address that you check regularly for communication about the day.

Mobile Phone Number *

Please type NA if you do not have a mobile phone.

Gender *

Male

Female

Date of Birth *

Please use the format dd/mm/yy

What city/town do you live in? *

Are you interested in being selected for the Northern Under 19 Ultimate squad? *

Those players selected in the Northern Regional Squad will compete against other regional rep teams at the New Zealand Ultimate Under 19 Championships in Taupo in April 2013. These players will also be eligible for selection to the New Zealand National U19 team, which will be selected from the NZ U19 Championship tournament.

Yes - I wish to trial!

No - I just want to attend for coaching.

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