Bialik Futsal Club - Player Registrations 2022/23
Contact Sarah 0437 025 223 Email victoria@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 Attending (if under 18)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a member of a team already (choose one below)
*
Yes
No Please place me in team
Team name / Coach name
*
Would you like information about becoming a Referee?
Yes - Please contact me
No
My Products
*
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Bialik Under 8s (Born 2014/15)
Starts 7th October
$
395.00
AUD
Bialik Under 10s (Born 2012/2013)
Starts 7th October
$
395.00
AUD
Bialik Under 12s (Born 2010/2011)
Starts 7th October
$
395.00
AUD
Bialik Under 14s (Born 2008/2009)
Starts 7th October
$
395.00
AUD
Bialik Youth (Born 2007/06/05/04/03/02)
Starts 7th October
$
395.00
AUD
Futsal Balls (Bialik)
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
2
3
4
5
6
7
8
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81
82
83
84
85
86
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88
89
90
91
92
93
94
95
96
97
98
99
100
Size 4 Ball
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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18
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98
99
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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