Are you attending this event?

Yes No

Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Team Particulars

Team name - State or other*

If other, please indicate a provisional name of your team

Competition Gender*

Men's Compeition

Women's Competition

Competition Age Group*

Over 34s

Over 40s

Over 45s

Over 50s

Over 55s

Over 60s

Other (or second team)

If other, what age group do you wish to submit a team in?

Team uniform colours

Shirt*

Skirt/shorts*

Socks (choose a light and a dark colour)*

GK smock*

Main points of contact

POC 1 Name*

POC 1 Phone No.

POC 1 email

POC 1 Potential Team Position*

Coach

Manager

Captain

Player

State MA representative

POC 2 Name*

POC 2 Phone No.*

POC 2 Email*

POC 2 Potential Team Position*

Coach

Manager

Captain

Player

State MA representative

Terms Of Registration

As the delegated team manager / point of contact, I confirm that I am currently registered with Hockey Australia either directly or via a Member Association and that all participants of my team are also registered with Hockey Australia either directy of via a Member Association.

It is noted that all members of my team are also bound to abide by the Hockey Australia Codes of Conduct as they apply to me and my team before, during and after the event.

I acknowledge that, as the delegated team manager / point of contact, I will be contacted further about this Expression of Interest, and that will include further details of payments, team nomination fees, and player lists that are payable and to be submitted to HA / HAMC to confirm our position in this event.

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

I agree to the Terms Of Registration.*

Already a member?

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