Tasmanian Senior Men's 15s Tour Player Nomination
Representative Player nominations are now open for the Tasmanian Senior Men's 15s Team. If you would like to be considered for this team, please complete the form below. Please note that there is a $50 nomination fee. This fee will be reimbursed if you are not selected or if you are injured. If you are selected the $50 will be your first payment towards your player levy. If you withdraw due to any other reason you forfeit the payment. You must also have paid $500 non-refundable deposit by Wednesday 22nd August, or you will be withdrawn from the team. The total levy is $1180
Name
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First Name
Last Name
Email
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example@example.com
Date of Birth
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-
Month
-
Day
Year
Date
Address
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Phone
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Current Club
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Preferred playing positions
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Please list your previous rugby club and representative playing experience (none is necessary)
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I understand that if I am selected to represent Tasmania I MUST pay the levy of $1180 in full no later than two weeks prior to departure (5th September 2018), unless I have arranged a payment plan with the Tasmanian Rugby Union in advance
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Yes
I understand that to be eligible for selection I must pay a $50 nomination fee into the below bank account which will go towards my player levy should I be selected. (Please note that this will be refunded to you in the event of injury or non-selection. If you withdraw from the team you forfeit this payment) Name: Tasmanian Rugby union Inc. BSB: 017010 Account No: 001242749 Bank: ANZ
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Yes
I understand that I must also have paid a $500 non-refundable deposit by Wednesday 22nd August, or I will be withdrawn from the team.
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Yes
Emergency Contact Name
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Emergency Contact Phone
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Submit
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