2018/2019 Post Xmas Summer Competition Open Age Women and Masters Men Registration Form 2018/2019 Post Xmas Summer Competition Open Age Women and Masters Men Registration Form Team Competition*Open Age WomenMasters MenTeam Name*Shirt Colour*Team will participate in the following competition*Post Xmas Open Age Women Summer Hockey Competition (Monday 7th Jan 2019 --> Friday 1st Mar 2019)Post Xmas Master Men Summer Hockey Competition (Monday 7th Jan 2019 --> Friday 1st March 2019)Contact Details of Team Captain/Team Manager/Team CoordinatorName* First Name Surname Address* Street Address Suburb State Post Code Home PhoneMobile Phone*Email*Please enter these details carefully as this is the address that your confirmation email and invoice will be sent to. EMERGENCY CONTACT DETAILS*This is the person we need to contact in a medical emergency. Yes (click here if details are as above) No (click no and enter emergency contact details below) Name First Name Surname Home phoneWork PhoneMobile PhonePhoto Permission (check one box)* I grant permission to have my team member's photos published in any club based media I do not wish to have my team member's photos published in any Club based media CommentsAny comments? Fill in belowTeam Nomination Fees*Team nomination fees are due by no later than Friday 18th January 2019.Bank details are as follows:Southern River Hockey Club IncBSB - 633-000A/C - 162907174Reference - Team Name Open Age Women Post Xmas CompetitionMasters Men Post Xmas CompetitionTotal $ 0.00 NameThis field is for validation purposes and should be left unchanged.
