ASA Representative Clinic
Registration Form
Due by: Wednesday, August 26th, 2015
Space is limited-Register early. Please check the appropriate slot.
Name:
Postal Address:
Post Code:
Email Address:
Age:
Phone Number:
Tick One: ___Male ___Female
Affiliated Club:
Which Age group will you be trialling for in the 2015/16 season? (Please note trialists must
always be available for their own designated age grade. If you wish to trial for an additional
age grade as well, please state. Players will only be open to clinics outside of their age grade
if spaces are available.)
What age group did you play in last year for your club?
___________________________________________________________________________
Did you play for a Representative Team last year? If so please state age grade &
Association.
__________________________________________________________________________________
Please state primary defensive position: _____________________________
Please State secondary defensive position: ____________________________
Which Module will you attend? Please check your appropriate age grade.
September 6th U19 Boys & Girls
September 13th U17 Boys & Girls
September 20th U15 Boys & Girls
September 27th U13 Boys & Girls
Payment Options (Check one):
______ Internet Banking
______ Cheque
Payment Details: $50 payment due to secure your registration
Internet Banking: Bank of New Zealand 02 0192 0143451 00 (please put surname as
reference & age group as details.)
Postal address: PO Box 26599 Epsom, Auckland City, Auckland 1344
Cheque payable to: Auckland Softball Association
Please email completed registration form to [email protected]