BWHA - 2025 Masters Representative Player Nomination

Details

Sun 30 Mar 2025 18:00 — Sun 13 Apr 2025 11:30
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Brisbane Women's Hockey Association, 16 Melbourne Street, Windsor QLD 4030

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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

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

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

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 Full-Time 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.*