JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Open Men State Teams Nomination Form - 2018
The Open Men's National Championships will be held in Hawker, ACT from 14-20 January, 2018
**If you are nominating for the first time please ensure to submit a copy of your birth certificate via
admin@softballwa.org.au
**
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Nominee Information
Full Name
*
Your answer
Street Address
*
Your answer
Suburb
*
Your answer
Post Code
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Phone (Home)
Your answer
Phone (Mobile)
*
Your answer
Email
*
Your answer
Confirm Email
*
Your answer
Emergency Contact
Full Name:
*
Your answer
Home Phone Number
*
Your answer
Mobile Phone Number
*
Your answer
Relationship to Participant
*
Your answer
Playing Positions
Please select your preferred playing position below (1/3)
*
Choose
N/A
Pitcher
Catcher
1st Base
2nd Base
3rd Base
Short Stop
Centre Field
Left Field
Right Field
Preferred playing position - 2nd Preference (2/3)
*
Choose
N/A
Pitcher
Catcher
1st Base
2nd Base
3rd Base
Short Stop
Centre Field
Left Field
Right Field
Preferred playing position - 3rd Preference (3/3)
*
Choose
N/A
Pitcher
Catcher
1st Base
2nd Base
3rd Base
Short Stop
Centre Field
Left Field
Right Field
Additional Details
Name of Current Affiliated Club/s
*
Your answer
Name of Association
*
Your answer
Are you an Australia Citizen
*
Yes
No
Name of Parent/Guardian
*
MANDATORY FOR ATHLETES UNDER 18 YEARS OF AGE. {Type N/A if over 18}
Your answer
Parent/Guardian Email
*
MANDATORY FOR ATHLETES UNDER 18 YEARS OF AGE. {Type N/A if over 18}
Your answer
Confirm Parent/Guardian Email
*
MANDATORY FOR ATHLETES UNDER 18 YEARS OF AGE {Type N/A if over 18}
Your answer
Medical Information
Does the participant suffer any of the following?
*
Please tick all that apply
None
Any Allergic Condition
Epilepsy, fits or blackouts
Asthma
Diabetes
Other
Required
Medical Information
*
If you suffer from any of the above please provide details here. {Type N/A if you have no medical information to declare}
Your answer
A NON-REFUNDABLE NOMINATION FEE IS REQUIRED VIA DIRECT DEPOSIT ONLY UPON SUBMISSION OF THIS FORM. YOUR AS REFERENCE PLEASE USE THE PLAYER’S SURNAME PLUS AGE GROUP & GENDER EG. SMITH 17 BOYS. PLEASE EMAIL RECEIPT OF PAYMENT TO:
admin@softballwa.org.au
NOMINATION IS NOT COMPLETE UNTIL PAYMENT HAS BEEN MADE.
Softball WA BSB: 016 353
Account Number: 262 446 416
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
