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2025 Club Glenvale Challenge - Team Official Nomination
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Sun 26 Jan 2025 08:00 — Fri 28 Feb 2025 21:00
Clyde Park, 564 Boundary St, Glenvale QLD 4350, Australia
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Basic details
First name*
Last name*
Phone number*
Email address*
Address*
Additional information
Which Club are you affiliated with*
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Newtown
Norths
Past High
Rangeville
Red Lion
No Club Affiliation
Which role are you nominating for?*
Manager - Men
Manager - Women
Coach - Men
Coach - Women
Coach - Junior
Manager - Junior
Junior Playing Mentor
Umpire
Referee - please enter the name and mobile number of one Referee*
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Do you have a Blue Card?*
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Is your Blue Card linked to the THA Blue Card Register?*
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Blue Card #*
Blue Card Expiry Date*
I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*
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