NDWHA PLAYER NOMINATION FORM

MASTERS NOMINATION FORM

To be completed by all players seeking to play in a Newcastle District Women's Hockey Association (NDWHA) representative field hockey team.It is an exciting time and we hope you have a wonderful season. If you wish to join us at the State Championships in Bathurst , please fill out the below form. We require an initial fee payment of $150 which will secure your spot in a team. This will form part of the 2019 fees which will be determined ASAP and will be deducted from the final total amount. Fees are yet to be determined for competition and we cannot advise until information for fees and payments have been worked out . Please note we have gone CASHLESS, no cash will be accepted at any stage. EFTPOS will be available and direct deposit payments are listed at the end of the form.
Player Name*

First NameLast Name
Birth Date

MonthDayYear
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number*
Club Affiliation*
Age Group*

35#1 PL & 2nd grade players only35 #240#245#250#155/60#1
Over 40#1 and Over 45#1 teams are now Full and ,no more nominations will be taken for these age groups.

A second team for 35's will only be considered if there is enough nominations to fill this team..
Playing Position 1st Choice*

Goal KeeperDefenderHalfDefensive Midfielder(DM)Attacking Midfielder(AM)Striker
Playing Position 2nd Choice*

Goal KeeperDefenderHalfDefensive Midfielder(DM)Attacking Midfielder(AM)Striker
Uniforms*

Already ownNeed to purchaseSkirt - Sml to MedSkirt - L to XLShirt -Sml to MedShirt - L to XL
Do you require Accommodation?*

YesNoPrefer non snorer
Who would you prefer to room with*
Conduct Declaration

NDWHA Code of Conduct. We advise that you remind yourselves of what is required as a participant, spectator or official during the State Championships competition. As a Association we as members are a Good Sports group and aim to conduct ourselves in a high professional manner on and off the field.Also on NDWHA web page there is a Social Media Policy which must be adhered too. We advise you to refresh your memory of this policy. Those who choose not to accept these or who breach throughout the Championships will be dealt with accordingly.
Permission - use of images

By completion of this form you agree to be bound by the following the NDWHA Social Media Policy. NDWHA reserves the right to use at it's discretion any photographic material of you in any form of media, art advertising, trade,visual documentary, promotional material, merchanise files coverage for the purpose of publicity/marketing without any compensation to you or approval by you.
Do you agree with the above statement?

YesNo
Confirm you have read, understand and accept the conditions in the Code of Conduct (available on NDWHA website)
Payments can be made by direct deposit to:

MASTERS

BSB: 012670

Account Number: 471482165

Reference your name.
Payment Verification I have paid via direct deposit*

YESNO
Please write your direct deposit reference here*
By signing this nomination form you confirm your understanding that a nomination Levy of $150 is payable upon submitting this form. There is also a non refundable amount of $100 if you withdrawal from any team.

NB. Use mouse to sign signature pad.
Signature*

Clear
Should be Empty:

MASTERS NOMINATION FORM

Conduct Declaration

Permission - use of images