2025 Country Championships TEAM LIST Nomination Form

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Details

Fri 24 Jan 2025 18:00 — Mon 27 Jan 2025 17:00

West Beach, Barratt Reserve, West Beach Road

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Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Additional information

Association Team Name*

Division*

Team Contact Person*

Team Contact Person Email*

Team Contact Person Contact Number*

Team Officials - Coach*

Team Officials - Coach - Contact Number*

Team Officials - Assistant Coach*

Team Officials - Assistant Coach - Contact Number*

Team Officials - Team Manager*

Team Officials - Team Manager - Contact Number*

Team Officials - Team Scorer*

Team Officials - Team Scorer - Contact Number* Max. 255 characters

Team Officials - Team Umpire

Team Officials - Team Umpire - Contact Number

Team Officials - Additional Umpire

Team Officials - Additional Umpire - Contact Number

1) Team Player - Name (as per RevSport)*

1) Team Player - Date of Birth*

1) Team Player - Permit From (if required)

2) Team Player - Name (as per RevSport)*

2) Team Player - Date of Birth*

2) Team Player - Permit From (if required)

3) Team Player - Name (as per RevSport)*

3) Team Player - Date of Birth*

3) Team Player - Permit From (if required)

4) Team Player - Name (as per RevSport)*

4) Team Player - Date of Birth*

4) Team Player - Permit From (if required)

5) Team Player - Name (as per RevSport)*

5) Team Player - Date of Birth*

5) Team Player - Permit From (if required)

6) Team Player - Name (as per RevSport)*

6) Team Player - Date of Birth*

6) Team Player - Permit From (if required)

7) Team Player - Name (as per RevSport)

7) Team Player - Date of Birth

7) Team Player - Permit From (if required)

8) Team Player - Name (as per RevSport)

8) Team Player - Date of Birth

8) Team Player - Permit From (if required)

9) Team Player - Name (as per RevSport)

9) Team Player - Date of Birth

9) Team Player - Permit From (if required)

10) Team Player - Name (as per RevSport)

10) Team Player - Date of Birth

10) Team Player - Permit From (if required)

11) Team Player - Name (as per RevSport)

11) Team Player - Date of Birth

11) Team Player - Permit From (if required)

12) Team Player - Name (as per RevSport)

12) Team Player - Date of Birth

12) Team Player - Permit From (if required)

13) Team Player - Name (as per RevSport)

13) Team Player - Date of Birth

13) Team Player - Permit From (if required)

14) Team Player - Name (as per RevSport)

14) Team Player - Date of Birth

14) Team Player - Permit From (if required)

15) Team Player - Name (as per RevSport)

15) Team Player - Date of Birth

15) Team Player - Permit From (if required)

Event Waiver

PLEASE ENSURE:
1.            ALL team players, officials and umpires MUST be registered for insurance purposes.
2.            ALL team members requiring permits must be submitted and completed online via RevSport.
3.            Permits are required to be completed no later than 5 JANUARY 2025

Nominations
Minimum number of players: 10 per Team
Maximum number of players: 15 per Team
Team nominations with a minimum of 6 players to be in by no later than 5 January.
Final teams and name of team umpire to be provided no later than 12 January.
A draw will be published on 17 January.

Age Requirements
Minimum age – must be 15 years of age as of 31 December 2024.

I confirm that I have read the above Event Waiver in its entirety.*

I agree to the Event Waiver.*

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*