NomForm Bun/Buss 2019

    Nominations will close on 1st April 2019 (But please do it now)

    Upon submission of the electronic nomination below you will considered for selection after agreeing to pay those fees levied by the ACT Masters Hockey Association.
    If not already a member of the ACT Masters Hockey Association, you also need to apply for membership.

    Player Costs for Bunbury
    The Team Player fee has not been set as yet (likely to be in the order of $420, depending on the number of teams). The levy covers Team entry, Physios and their materials, B & F trophies and gifts as well as the hospitality tent drinks.

    Transport to and from Bunbury is the responsibility of each player.
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    PLEASE NOTE: We are currently experiencing an issue with this form, the data IS being recorded, but the notification email isn't geting to you and the following error -"There was an error trying to send your message. Please try again later." will result. There is no need to resubmit.
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    Gender
    MaleFemale

    With the date picker below, in some web browsers you will get a neat calendar to choose from, others will only allow you to click on day/month/year and change them as required. For those of us born decades before 1982 that's preferable to scrolling through the calendar anyway.

    Age division

    Player and or official?

    Do you want ACT Masters to arrange accommodation?
    YesNo

    Do you have a ACT nationals playing shirt?
    YesNo

    Shirt(s) number(s)

    Address (please don't use commas)



    A deposit of $250.00 is required to secure your place in the Team and is due by 1st April 2019.

    Payment method preferred is Electronic Funds Transfer details are:

    BSB : 801 009
    Account number: 10001 3909
    Account Name: ACT Masters Hockey Association
    Reference: Your Surname/Age division (for example Charlesworth/65)

    It is vital to put your name and team as a reference:

    If you have no EFT facility you may post a cheque to payable ACT Masters Hockey Association.

    The Postal address is:
    The Treasurer,
    PO Box 986 Queanbeyan NSW 2620