Queensland Niue Rugby League Club
Club Membership Registration for the 2024 Season
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of birth
-
Day
-
Month
Year
Gender
Taane - Male
Fifine - Female
Please select your Niue maaga/village?
Alofi Toga
Alofi Tokelau
Makefu
Tuapa
Namukulu
Hikutavake
Toi
Mutalau
Lakepa
Liku
Hakupu
Vaiea
Avatele
Tamakautoga
Niue Family Name - This is to establish your Niue Magafaoa/lineage
Are you currently a registered QRL Club Player?
Name of QRL or Sport Club?
NRL ID number
Please select which grade you qualify for?
Under 10 Mixed (9-10 years)
Under 12 Mixed (11-12 years)
Under 14 Boys
Under 16 Boys
Under 18 Boys
Open Men
Under 15 Girls
Under 17 Girls
Open Women’s
Player Registration Fee: Registration fee will be non-refundable if you have been selected to represent one of the listed teams.
Agree
Disagree
Do you understand and accept the risks that are involved during training and match days at QPICC?
Yes
No
Other - need clarification
Do you consent to receive promotional from QNRL, QPICC and QRL
Yes
No
Other
Please declare any medical condition we need to be aware of such as asthma, allergies etc?
Do you accept the QRL, QPICC and QNRL Codes of Conduct for Administration, Coaches, Officials, Players, Parents, and Spectators
Yes
No
Other
Do you declare the information you have provided is true and accurate?
Yes
Do you accept QNRL terms and conditions
Please Select
Yes
No
Other
Continue
Continue
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