In order to maintain our duty of care to our members, and to keep your details current we require that you submit this form (or the paper equivalent) every year. Thanks for your cooperation! Please fill in the form below and hit the submit button.

Club Registration Information

1. Fields marked with * are required.

2. Name *
3. Current Shirt Number * If you don't have a shirt, just write "I don't have one"
4. Are you a new member? * I'm a new member in 2011 I'm an existing member, just renewing
5. Membership Type * Senior ($155) Full Time Student ($120) Junior - Under 19 Years ($80)
6. Date of Birth (dd/mm/yy) *
7. Address Line 1 *
8. Address Line 2
9. Suburb *
10. Postcode *
11. Mobile Number*
12. Email Address*
13. Current Refereeing Level * None Some Experience but Never Accredited District (have gone to a course) Regional (have gone to a course and refereed some games) State (have good experience refereeing) National (have refereed at national competitions)
14. Current Coaching Level * None Some Experience but Never Accredited Level 1 (Have gone to a Course) Level 2 (Very experienced)

Personal Details

15. Gender * Female Male
16. Age*
17. Height*

Emergency Contact

18. Full Name*
19. Contact Phone 1* Your emergency contact's mobile number would be best.
20. Contact Phone 2
21. Relationship* The relationship you have to your emergency contact, for example "Father"

Health Care Details

22. If Yes, Your Insurance Fund?
23. Doctor's Name
24. Doctor's Phone
25. Doctor's Address
26. Dentist's Name
27. Dentist's Phone
28. Dentist's Address

Current History

29. Current Medical Problems * If you don't have any, just write "No current medical problems"
30. Current Medications * If you aren't taking any, just write "I'm not taking any"
31. Allergies * If you don't have any, just write "No allergies"