Player Information

First Name *

Last Name *

Date of Birth *

Address *

City *

State *

Postal Code *

Email Address *

Phone *

Grade at School this year (if applicable)

Membership Class *

Playing Member

Social Member

What level would you like to play this season (please select one) *

Additional information: e.g. allergy, health condition, special requests

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Please contact Jeff Wootton, 0429 800 090 if you have any queries.