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2019-20 State Representative Team - Expression of Interest

Please complete the form below to express your interest in either 
  • U17-Open Ocean/Beach Interstate Championship team, or
  • Youth Pathway Cup (U14/15) team.

To contest their relevant events at Alexandra Headland on Friday 24 January 2020. The group will also compete at the Murphy Homes carnival at Maroochydore on the weekend.

BY NO LATER THAN 10am, Tuesday 26 November 2019
 
1.Personal details(Required.)
2.2019-20 Age Group(Required.)
3.AVAILABILITY: I confirm that I am available to travel with the team to the event in Alexandra Headland, departing Adelaide on Thurs 23 Jan (AM) and returning on Mon 27 Jan (PM).(Required.)
4.MEDICAL CONDITIONS &/or INJURIES - do you have any?
5.EMERGENCY CONTACT
6.TEAM UNIFORM SIZING
Mens XS / Womens sz 8
Mens Small / Womens sz 10
Mens Medium / Womens sz 12
Mens Large / Womens sz 14
XL
XXL
Polo Shirt
T-shirt
Shorts
Hoodie/Jacket
7.SWIMWEAR style & sizing (please choose style preference & specify size below)
8.DECLARATION: I acknowledge & confirm the following:
9.CLUB ENDORSEMENT - please provide details of Club Board/Committee member who endorses your EOI