Hervey Bay Futsal Club - Player Registrations
PCYC 9 O'Rourke Street Hervey Bay - Contact Peter Souvlis 0458 003 145 Email widebay@australianfutsal.com
Player name
*
First Name
Last Name
Parent/Guardian (if player under 18 Years)
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Player Date of Birth
*
-
Day
-
Month
Year
Date
School Attended (if under 18)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please tell us your team name and team contact / if known
*
Please Choose below
*
I am in a team already, no need to place me in a team.
I am not in a team and would like to join a team, please contact me
Would you like information about becoming a Referee?
Yes - Please contact me
No
My Products
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Hervey Bay Under 7/8s
Starts 10th October till 5th Dec 2022
$
150.00
AUD
Hervey Bay Under 9/10s
Starts 10th October till 5th Dec 2022
$
150.00
AUD
Hervey Bay Under 11/12s
Starts 10th October till 5th Dec 2022
$
150.00
AUD
Hervey Bay Under 13/14s
Starts 10th October till 5th Dec 2022
$
150.00
AUD
Hervey Bay Open Mens
Starts 10th October till 5th Dec 2022
$
150.00
AUD
Hervey Bay Social Mixed
Starts 10th October till 5th Dec 2022
$
150.00
AUD
Hervey Bay Futsal Balls
Futsal Ball size 3 and 4 available** Price includes Postage (Aust). Goods posted to Address above.
$
44.00
AUD
Size
Quantity
Size 3 Ball
1
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100
Size 4 Ball
1
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100
Pay with Credit Card
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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