U18 Nomination Form

U18 Southern Cross - Toowoomba - July 17

U18 State Championships - Townsville - September 22 to 25

Nominations Close: June 30, 2011

* First Name

* Last Name

* Address

* Suburb

* State

* Postal Code

* Home Phone Number

* Mobile Phone Number

* Email Address

* Date of Birth

* Club

* Club Playing Number

* Team Number

* Division

* Previous Playing History (2010)

* 1st Playing Position

* 2nd Playing Position

Nominations subject to BWHA Rules of Association & By-Laws.

* Indicates Response Required