Shepparton Touch Association
Expression of Interest Form
Participant Details:
Full Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
How would you like to get involved?
*
Player
Coach
Referee
Volunteer
Committee Member
Please outline your prior experience as a player/coach/referee/volunteer below
*
Parent / Guardian Details:
If participant registering under 18
Parent / Guardian Contact
First Name
Last Name
Parent / Guardian Email
example@example.com
Parent / Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
How did you hear about us?
*
Social Media
Word of Mouth
Newspaper
Other
Would you be interested in pathways to represent our touch community or state?
*
Yes
No
I will be attending the Shepparton Touch Association AGM (Dec 4th 7pm)
*
Yes
No
Any questions or queries please add here:
Submit
Should be Empty: