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Details mark with * are mandatory - if information is not available please type in NA
 
 *CONTACT DETAILS:
GENDER:
AGE GROUP:
NAME:
ADDRESS:
SUBURB:
POST CODE:
HOME PHONE NUMBER:
WORK PHONE NUMBER:
MOBILE NUMBER:
EMAIL ADDRESS:

*Declaration:
I hereby agree to be solely responsible for all cost for ourself to play for the season. Further more, I will abide by all of the rules and regulations* set down by Pure Touchfootball Association for the entire length of the season. (*see Rules & Regulations)
Privacy: I agree that the contact details disclosed above can be used by Pure Touchfootball to contact me regarding competitions for this and future seasons. If I nominate a group or individual the contact details can be provided to the manager of the team the player are placed in. Information will not be disclosed to third parties. 
*VENUE AND NIGHT SELECTION:
Monday
Yeronga
Wednesday
Yeronga
*GRADE SELECTION:

MEN'S

MIXED

WOMEN'S
Please conform if your team has ever played in an administered touch football competition before:
If so may we ask which competition?

OTHER RELEVANT INFORMATION:

 

Please conform if your team has ever played in an administered touch football competition before:
If so may we ask which competition?

OTHER RELEVANT INFORMATION:

*PAYMENT SELECTION:
I will post a cheque or money order to GPO Box 3178 Brisbane Q 4001
I will pay by Credit Card by contacting the office on 3879 2192

 

 

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