2019 Pre Xmas Summer Competition Walking Hockey Registration Form 2019 Pre Xmas Summer Competition Walking Hockey Registration Form Team Name*Shirt Colour*Team will participate in the following competition*Pre Xmas Summer Hockey Competition running from Monday 14 October to Friday 20 December 2019Walking Hockey-all agesUmpire*Home team to supply an umpire each week Umpire can be provided for $20 cash per game. To be paid to the umpire before the start of each gameOwn UmpireSRHC to supply UmpireContact 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 photo's published in any club based media I do not wish to have my team member's photo's published in any club based media CommentsAny comments? Fill in belowTeam Nomination Fees*Team nomination fees are due by no later than Friday 5 Oc t 2019.Bank details are as follows:Southern River Hockey Club IncBSB - 633-000 A/C - 162907174Reference - Team Name Walking HockeyTotal $ 0.00 EmailThis field is for validation purposes and should be left unchanged.