2012 SEJ MFC Clinic Registration

2012 South East Juniors - Melbourne FC Clinic Registration

AFL Victoria, the South East Juniors and the Melbourne Football Club will be running a free clinic for girls aged 13-18 on April 3 at 1:30pm.

Please provide your details here to register.

For more information contact:
Chyloe Kurdas
Female Football Development Manager
AFL Victoria
03 8341 6042
chyloe.kurdas@aflvic.com.au
www.youthgirls.aflvic.com.au

www.facebook.com/AFLVICYouthGirls

Participants' Details

Participants' Details Participant's first name
Participant's surname
Address
Suburb
Postcode
Contact phone
Participant's email
Parent's first name
Parent's surname
Parent's email

Participant's Date of Birth

	DD		MM		YYYY
DOB	Participant's Date of Birth DOB Day	/	Month	/	Year

Which AFL club does the clinic participant support?

	Club Supported
Club supported	Which AFL club does the clinic participant support? Club supported Club Supported

Is the clinic participant a member of their supported club?


Is the clinic participant a member of the AFL club they support?	Is the clinic participant a member of their supported club? Is the clinic participant a member of the AFL club they support?

Did the clinic participant play at a football club in 2011?

Did the clinic participant play at a football club in 2011? Yes