Registration Form

Player Details

* Indicates required field

Players Name *

First

Last

Date of Birth (dd/mm/yy) *

Male/Female *

Male Female

Players Email Address *

Home Phone No *

Players Mobile *

Parents Name *

First

Last

Parents Email Address *

Parents Mobile *

Current School and Year (if applicable) *

Are You a 2019 Rep Player? *

Yes No

Team Name *

Manager's Name *

First

Last

Manager's Email *

Manager's Mobile *

Payment Method *

Credit Card (see form on the Payments page) Direct Deposit (details on the Payments page) Cash/Cheque (details on the Payments page)

Additional Information *

Submit