2012 Strikers Representative Squad Nomination Form
Full Name: ………………………………………………………………………………………………
Address: ………………………………………………………………………………………………
Town:
Contact No's:
Player:
Parents:
………………………………………..
Postcode: ……………..
Home:
…………………………………………………………….
Work:
…………………………………………………………….
Mobile:
…………………………………………………………….
Email:
…………………………………………………………….
Mobile:
…………………………………………………………….
Affiliated Club:…………………………………………………………………………Date of Birth:………………………
Preferred Positions: 1. …………………………………………
2. ………………………………………………..
It is important that we are able to contact you to provide you with further or updated information.
Please ensure that if your contact details listed above change you notify admin@hockeyalbury wodonga.
This year Strikers will be playing in State League Two This will possibly involve a possible 11 away games in Melbourne
and surrounding area and 8 in Albury
Signature of Player or Parent/Guardian if Under 18.