NSW Harmony Cup 2023
Expression of interest
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Female
Male
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your Niue Family Name (If known)
Which village(s) do you come from?
Alofi
Avatele
Hakupu
Hikutavake
Lakepa
Liku
Makefu
Mutalau
Namukulu
Tamakautonga
Toi
Tuapa
Vaiea
Other
Please select the option you are interested in?
*
Qualified Manager
Coach
Trainers
U5yrs Girls
U11yrs Girls
U16yrs Girls
U18yrs Girls
Open women’s
U5yrs Boys
U11yrs Boys
U16yrs Boys
U18yrs Boys
U21yrs Mens
Open men’s
Mixed Flag
Are you currently a registered NSW club member? If yes, name club
*
NRL Player ID Number
Player registration fee: A $150 non refundable player fee will be required if you have been selected to represent one of the listed teams listed
*
Please Select
I agree
Medical Conditions/Information (inc any allergies)
Pre-exisiting Injuries
Do you understand and accept the risks that are involved during training and match days?
*
Yes
No
Do you declare the information you have provided is true and accurate?
*
Yes
No
Comments
Signature
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