2017 Australian Floorball Open
The 2017 Australian Floorball Open will be held in Pakenham, Melbourne between the 5th and 8th of
April.
Applications will close on the 24th of January and no further submissions will be accepted after this
date. Detailed below are the requirements that must be met in order to be considered for selection:


Current Full Membership with Floorball Australia
Currently competing in a 5 a side structured competition
IMPORTANT: All nominating players are required to pay a $100 deposit by the closing nomination
date. This will enable the association to book accommodation, travel and tournament fees at the
lowest possible cost for players. Any player who is not selected in the team with have their deposit
fully refunded. Please find below the account details. Transfers are to be made to the below bank
account:
BSB: 082 847
Account Number: 57 593 3060
Account Name: Newcastle Floorball Association
Reference: “Your Name” AFO
ALSO IMPORTANT: Official AFO training will begin on 19th January from 6pm-7:30pm at St Marys,
Gateshead. This is a mandatory training for all nominating players.
Please complete the application form below and if you have any questions or concerns please
contact: [email protected]
Kind regards,
Shane Abell
Shaun Frazer
Andrew Woods
(Selector)
(Selector)
(Selector)
2017 Newcastle Cobra’s AFO Nomination Form
PERSONAL DETAILS
NAME
DATE of BIRTH
ADDRESS (including post code)
PHONE (Home)
PHONE (Work)
MOBILE
EMAIL: please be sure this is entered clearly:
Registered with (Association)
Playing with (Social Team)
OTHER DETAILS
Playing position: See circle below:-
1st Preference
Defender
Centre
2nd Preference
Forward
Shirt number (Preferred):
(2nd Preference):
Have you any medical condition that may affect your performance?
Yes/No:
Do you have any injury that may affect your performance?
Yes/No:
Please indicate if any (not including yourself) additional persons (eg parents,
partners etc) will also be traveling with you and require accomodation
NOTES (In relation to questions above)
DECLARATION
I hereby nominate for selection for the Newcastle Cobra’s to compete in the Australian Floorball Open. I have read the
current player information sheet and understand the availability, travel and training requirements as well as
accommodation and payment arrangements. I acknowledge that NFA has the right to revoke my position at any time if
I do not adhere to this agreement.
Sign/Type
Please return form to: [email protected] by the 25th of January 2017.
Date