2019 Junior State Cup Player Pool Application
This form is designed for clubs to submit players from within their association to participate at the 2019 Junior State Cup, as their association is not entering teams in the respective division the player wishes to participate in.

Players are only eligible to participate for another affiliate within their own Conference event (either North or South not both). Players drafted to a team for the Northern or Southern Conference event are able to continue participating for that team should they progress.

Only the nominated Affiliate Coordinator of an association can complete this form on the players behalf. No player can fill in this form themselves.

Please note that this application form will close on 5pm Wednesday 16th January, 2019.

If you have any questions on this process please contact;
Keith Lee
NSW Touch Football Events Coordinator
E: keith.lee@nswtouch.com.au
P: 02 9558 9333
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Current Affiliated Club *
Player must be registered and participating in Season 2 2018 or Season 1 2019
Eligible Conference *
Player Name *
Player Date of Birth *
dd/mm/yyyy
MM
/
DD
/
YYYY
Player Home Address *
No/Street/Suburb/Post Code/State
Player Mobile Phone Number *
Player Email Address *
Parent/Guardian Details
Please complete the parent or guardian contact details.
Parent or Guardians Full Name: *
Parent or Guardians Mobile: *
Parent or Guardians Email: *
Division wishing to Play *
Please choose 3 options
18 Girls
18 Boys
16 Girls
16 Boys
14 Girls
14 Boys
12 Girls
12 Boys
10 Girls
10 Boys
8 Girls
8 Boys
1st Choice
2nd Choice
3rd Choice
Preferred Playing Position *
Affiliate Coordinator Verification-Name *
(This must be the current Affiliate Coordinator & not the player or someone else applying)
Affiliate Committee Member Verification-Mobile Number *
(This must be the current Affiliate Coordinator & not the player or someone else applying)
Affiliate Committee Member Verification-Email Address *
(This must be the current Affiliate Coordinator & not the player or someone else applying)
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