Details

Fri 01 Nov 2024 9:00AM — Fri 31 Jan 2025 12:00PM

State Hockey Centre, 400-420 Lytton Road, Colmslie

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Are you attending this event?

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First name*

Last name*

Phone number*

Email address*

Address*

Your Full Name*

DOB*

Email Address*

Mobile Number*

Age Group Nominating For*

U12

U14

U16

U18

Opens/U21

Were you a BHA Rep Official in 2024?*

If yes, what was your role? (if no type n/a)* Max. 255 characters

Do you have a son in your nominated age group?*

Do you have a Blue Card or Exemption Card?*

Blue Card/Exemption Card Number?

Blue Card.Exemption Card Expiry Date

Club Affiliiated with?*

Is there anything else you woud like us to know? Max. 255 characters

All BHL players registering must be registered & financial within a Club and within Brisbane Hockey Association.

If Selected you will be asked to read, sign, and adhere to a Selector Code of Conduct and a Selectors Agreement.
All inquiries asked of you are to be referred directly to the HDC at either hdc@bha.org.au or 0493 815 459.

I confirm that I have read the above Terms Of Registration in its entirety.*

I agree to the Terms Of Registration.*

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