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1. Name (Required.)

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2. Email (Required.)

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3. Mobile (Required.)

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4. Date of Birth

Date

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5. Please select your preferred division to play in for the 2020 State of Origin. (Required.)

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6. What Affiliate did you play for at 2019 QLD State Cup? (Required.)

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7. What division did you play in at the 2019 QLD State Cup?

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8. What Region will you be playing for at the 2020 NTL's?

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9. What division will you be playing in at the 2020 NTL's?

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10. Please detail your Elite Touch Football activity over the past two (2) years (Required.)

The State of Origin selection policies pertaining to the 2020 State of Origin are available to view on the Queensland Touch website www.qldtouch.com.au in the Tournament tab in State of Origin Documents & Policies information.

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