Easts Rugby: 2020 Player Registration

2020 Player Registration

Ticket Information

Type

Available Until

Price

Booking Fee

Quantity

Senior Men's Registration

Ended

$400.00

None

Colts Men's Registration

Ended

$400.00

None

Total:

$149

Example Only

(Your tickets will be displayed when viewing the actual event)

Registration Details

First name *

Last name *

Email address *

Re-enter your email address *

Date of Birth*

Height (cm)*

Weight (kg)*

Contact Details

Mobile *

Street Number*

Street Name*

Suburb*

Postcode*

Emergency Contact

Emergency Contact - Full Name*

Emergency Contact - Mobile Number*

Emergency Contact - Relationship To You*

Career Education

Place of Birth (Town / Suburb)*

Place of Birth (State)*

Place of Birth (Country)*

If born outside Australia, how long have you been in Australia (years & months)*

Secondary Education (High School)*

Are you completing or have completed a Tertiary Education / Trade Qualification*

Place of Tertiary Education (University / TAFE)*

Degree / Qualification*

Current Job*

Current Employer*

Rugby

If clearance is required please advise your previous club's name.*

Represenative Honours (Optional) - Honour / Year*

Did you play for an Easts age group representative team and if so what age groups & years*

Medical

Do you have private health insurance*

Please check box if you have or currently suffer from any of the following conditions*

Do you have any allergies

Do you take any regular medication

If yes, what medication do you take AND do you require it to be with you for game days or training*

I accept the terms and conditions.

Thank you! Your registration was successful.

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