PORT PIRIE TRAINING CAMP - GOAL KEEPER - JANUARY Senate Road Complex
Registration form
Personal Information
Parent/Guardian
Name
*
First Name
Last Name
Email
*
example@example.com
Age Group
*
8-11 Year Old
13-16 Year Old
Dates (9.30am - 1.00pm)
*
Monday 8th January ONLY
Wednesday 10th January ONLY
Both Days (8th & 10th)
Player details
*
Has any player been identified as living with a disability?
*
Yes
No
Please specify
*
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GK School Holiday Camp ***ONE DAY ONLY***
Please buy a ticket for each player
$
55.00
AUD
Quantity
0
1
2
3
4
5
6
7
8
9
10
GK School Holiday Camp ***BOTH DAYS***
Please buy a ticket for each player
$
110.00
AUD
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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