BWHA - 2025 U18 Representative Player Nomination

Details

Mon 24 Feb 2025 18:00 — Sun 02 Mar 2025 11:30
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Brisbane North Hockey Centre, Burringbar Park, Kittyhawk Drive

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First name*

Last name*

Phone number*

Email address*

Address*

Players First Name*

Players Surname*

Date of Birth*

Mobile Number*

Primary Email Address*

Do you require all correspondence to be sent to a second email address?*

Second email address

Parent/Guardian Name 1 (18+ type N/A)*

Parent/Guardian Name 2

Club*

What Division you are registered in? (this is your primary team that you play your most hockey with)*

Do you play in any other Division? (I.e. subsitute/fill in)*

Club Playing Shirt Number*

Preferred Playing Position*

Secondary Playing Position*

Did you play Representative Hockey in 2024?*

If yes, please list any Representative Teams in 2024 Max. 255 characters

Do you have any current injuries/medical concerns? Max. 255 characters

Are you unavailable for any trial/training/tournament dates? (please list reason(s) why)

Do you consent to be photographed and/or videoed?*

Is there anything else you would like us to know? Max. 255 characters

Please note

Please note to complete your nomination, trial payment must be paid on submission.

You must be a Primary Registered BWHA Member to nominate for a Brisbane Representative Team

I confirm that I have read the above Terms Of Registration in its entirety.*

I agree to the Terms Of Registration.*

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*