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Details

2024/2025 Hockey Vic INDOOR State Team Nomination

Thu 10 Oct 2024 08:00 — Fri 01 Nov 2024 23:00

State Sport Centres, Parkville, 10 Brens Drive, Parkville, ViC

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Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Preferred Playing Position?*

Forward

Mid

Back

GoalKeeper

GENDER*

D.O.B*

Have you read & agree to Hockey Victoria's Policies located on the description page?*

Yes

Athlete Mobile

Emergency Contact 1 NAME*

Emergency Contact 1 EMAIL*

Emergency Contact 1 MOBILE*

Emergency Contact 2 NAME

Emergency Contact 2 EMAIL

Emergency Contact 2 MOBILE

Will you travel by AIR with the team to Canberra?*

Will you return by AIR with the team?*

Select tickets

U14 BOYS Nomination

$50.00 ea

U14 GIRLS Nomination

$50.00 ea

U16 BOYS Nomination

$50.00 ea

U16 GIRLS Nomination

$50.00 ea

U18 MENS Nomination

$50.00 ea

Open Mens

$50.00 ea

Expired

Open Women

$50.00 ea

Expired

U18 Womens Nomination

$50.00 ea

U21 Women's Nomination

$50.00 ea

Expired

U21 Men's Nomination

$50.00 ea

Expired

Please note

All prices are inclusive of GST.

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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