*1.First name:(Required.)

*2.Last name:(Required.)

*3.Email:(Required.)

*4.Mobile number:(Required.)

*5.Date of birth:(Required.)

*6.University/TAFE:(Required.)

*7.Student number:(Required.)

*8.Current tertiary course (eg. Bachelor of Business):(Required.)

*9.Anticipated year of graduation:(Required.)

*10.Primary playing position:(Required.)

*11.Secondary playing position:(Required.)

*12.Heights (cms):(Required.)

*13.Weight (kgs):(Required.)

*14.Current rugby league club and team:(Required.)

*15.Highest level of competition played:(Required.)

*16.Coach and coach's contact details for playing reference:(Required.)

Coach's Name:

Coach's contact number: