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Membership Form (copy and paste)

Please use BLOCK LETTERS and answer all questions

Please also not any medical condition which may affect your play

Name:                                                                                                                                                                                                                                                            Sex:

 

Male

Female

Address:                                                                                                                                                                                                                                          

 

 

Ph/Fax/Mobile:

 

 

Email address:

 

Occupation/School:

 

Club name:

 

Category: (please circle applicable boxes)

U12

Wed

nights

U15

wed nights

Snrs

Tue nights

State League team

Aus titles

April 6+7 in Melbourne

Otherplease specify

Player

Scorer

$ collector

Coach

Referee

Volunteer

Signature (of player or parent/guardian) agree to pay full fees:

 

day

mth

2002

Office Use only

Date received

Amt AFA fees

Match fees

Receipt #

initial

 

      /      /2002

 

 

 

 

Thanks for joining us to play floorball!
 
Look forward to a great year.