2024/25 Boys Nomination

Boys Nomination

Name(Required)

First Last

Date of Birth(Required)

Gender(Required)

Email to be used for all communications from the club(Required)

Secondary email email to be used for all communications from the club * if applicable

Player Mobile Number if they have one

Address(Required)

Street Address Suburb Postcode

Are you of Aboriginal and/or Torres Strait Islander origin?(Required)

Do you identify yourself as living with a disability/disabilities?(Required)

Please list the disability/disabilities you identify living with

Emergency Contact Name(Required)

First Last

Relationship to Player(Required)

Emergency Contact Mobile Number(Required)

Position #1(Required)

Position #2(Required)

What Club did you play for in 2024?(Required)

What age group and grade did you play in 2024?(Required)

Are you a School Boarder?(Required)

Would the player or parent/caregiver be interested in coaching for Summer 2024/25?(Required)

Please provide name, contact details, experience and preferred age group to coach(Required)

Would the player or parent/caregiver be interested in umpiring for Summer 2024/25?(Required)

Please provide name, contact details and experience of umpiring(Required)

Do you have any existing medical conditions/illness/allergies?(Required)

Please list your existing medical conditions/illnesses/allergies(Required)

Please note that all Winter Nomination Fees must be paid at time of nomination.

Nomination Fee(Required)

All Grades ($200)

Processing Fee

Total

Credit Card(Required)

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Phone

This field is for validation purposes and should be left unchanged.