Tasmanian Representative 7s Player Nomination

Tasmanian Representative 7s Player Nomination

Representative Player nominations are now open for the Tasmanian Representative 7s Teams. If you would like to be considered for these teams, 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. The levy for the Senior Men and U17 Boys teams is $1100. The levy for the U17 Girls team is $1150 and the levy for the U15 teams is $270.
Name *

First Name Last Name
Email *
example@example.com
Parent's Email (if Under 18)
example@example.com
Date of Birth *

- Month - Day Year
Date

Address *

Phone *
Current Club *
School (if applicable)
Team you are nominating for *
Please list your previous rugby club and representative playing experience (none is necessary)
I understand that if I am selected to represent Tasmania I MUST pay the levy in full no later than two weeks prior to departure (Thursday 22nd November 2018). The levy for the Senior Men and U17 Boys teams is $1100. The levy for the U17 Girls team is $1150 and the levy for the U15 teams is $270. *

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 *

Yes
Emergency Contact Name *
Emergency Contact Phone *
Should be Empty: