Questions for State Player Nominee's

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* 1. Which State Team Category are you nominating for?

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* 2. Please enter the following information

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* 3. Date of Birth

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* 4. Please list your 3 preferred playing positions

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* 5. Name of Current Affiliated Club

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* 6. Name of Association

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* 7. Are you an Australian Citizen

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* 8. Name of Parent/Guardian if U18 years of age

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* 9. Email Address of Parent/Guardian

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* 10. Mobile Phone Number of Parent/Guardian

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* 11. Do you have a medical condition that we should know about?

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* 12. If Yes please provide details:

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* 13. On completion of this nomination you understand you must deposit $10 to be eligible to trial for a WA State Team?

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