Player Entry Form
Masters of Rugby League Australia (Inc)
Please enter the following player in the Masters of Rugby League
Organisation.
I agree to strictly obey and abide by the rules and code of conduct of the
Masters of Rugby League
Please print in block letters and fill in all sections .
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Name………………………………………………………………Club…………………..
Address………………………………………………………………………………..
Phone.............................. Mobile................................... Email....................................
AGE……….yrs when joining.
Date of Birth...........................Photo I.D.2 Passport photos
PLEASE CIRCLE ONE: OLD PLAYER
NEW PLAYER
Shorts Colour........35-39 White; 40-49 Black;
50-59 Red;
CHANGE OF CLUB
60 and Over Gold
Fees......... $60.00 Lifetime Registration and $40.00 annual administration Fee per
Player and current Insurance is $75.00 per season
Next of Kin……………………………………………………………………………
Contact Phone number........................................................(in case of injury)
I hearby declare that the information provided in this registration form is true and correct. I also
confirm that I will pay any insurance levy required and accept the terms and conditions therein.
Signed………………………..Date…………………
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