Pure Touchfootball - Individual Nomination From

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