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* 1. Name of Zone(s) applied for:

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* 2. Full name:

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* 3. Contact address:

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* 4. Home phone:

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* 5. Business phone:

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* 6. Mobile:

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* 7. Email:

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* 8. NZ citizen?

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* 9. Knowledge of experience in the sport of rugby league

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* 10. Knowledge of community-based programmes and work with central and/or govt. agencies and commercial sponsors

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