Pure Touchfootball - Team Nomination From

All Fields in the sections below marked with * are mandatory - if no information is available please type NA Also only team names that are in good taste will be accepted by the Management Committee
*TEAM NAME DETAILS:
TEAM NAME:
*PRIMARY TEAM CONTACT:
CONTACT NAME:
ADDRESS:
SUBURB:
POST CODE:
HOME PHONE NUMBER:
WORK PHONE NUMBER:
MOBILE NUMBER:
EMAIL ADDRESS:
SECONDARY TEAM CONTACT:
CONTACT NAME:
ADDRESS:
SUBURB:
POST CODE:
HOME PHONE NUMBER:
WORK PHONE NUMBER:
MOBILE NUMBER:
EMAIL ADDRESS:
*Declaration and Privacy:
We hereby agree to be solely responsible for all cost for yourself to play for the season. Further more, we 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.
*NIGHT AND VENUE 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:

*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