Country Champs Nominations

1

Nomination for:

Player

Coach

EO

Scorer

Umpire

2

Age Group* This field is required.

U10 - Zooka - 2016 & 2017 born

U12 - 2014 & 2015 born

U14 - 2012 & 2013 born

Opens A Grade

Opens B Grade

3

Players Name

First Name

Last Name

4

Name of Support Person (e.g. Coach/Scorer/EO/Umpire who in nominating)

First Name

Last Name

5

Parents Name

First Name

Last Name

6

Email

example@example.com

7

Phone Number

Please enter a valid phone number.

8

Date of Birth

Date

9

Coach ExperiencePlease outline your experience, your current accreditation and why you would like to nominate.