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U18W Indoor (18-20 Oct) South Brisbane□
U18M Indoor (18-20 Oct) Sunshine Coast□
Super 6s W Indoor (25-27 Oct) Maryborough□
Super 6s M Indoor (25-27 Oct) Kedron There is a once of non-refundable $20 fee for trialling again this year, to help offset venue costs. Paid at first training session.Ipswich Representative Player Nomination Form 2019
This form is to be completed and emailed to [email protected] by Saturday 21st September 2019
Team nominating for:
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Super 6W□
Super 6M□
U18W□
U18M□
U15W□
U15M□
U13W□
U13M (tick response)Name
Email DOB: / /
Home Phone: Mobile:
Will be registered primary Ipswich with Hockey Qld for Indoor season 2019/20
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Yes□
No(tick response)
Preferred playing position Previous Indoor experience
Please note:
By nominating for this team, I realise that the player travels and stays with family members and is responsible for all travel costs incurred, and needs to follow IHA codes of conduct. I have read and understood the code of conduct for players/spectators.
_________________________
Full name of parent if player U18 years
______________________
Signature of player
__________________________ ______________________
Signature of parent if player U18 years Date
□
U13W Indoor (1-3Nov) Mackay□
U13M Indoor (8-10 Nov) Maryborough□
U15W Indoor (15-17 Nov) Maryborough□
U15M Indoor (1-3 Nov) MaryboroughIPSWICH HOCKEY ASSOCIATION INC.
Established 1931
