2026 Complete Registration Form

RLSQ 2026 - Registration Closes Monday 22 June

Are You Using A FAIR PLAY VOUCHER ? YES ? Do NOT USE This Form 1. Email Vouchers to - enquiries@rugbyleaguesamoaqld.com 2. Our Team Will Process Voucher and Send You A Different Link To Register 3. Send Voucher Before Saturday Midnight
Players Name

First NameMiddle NameLast Name
Registered Email Address
example@example.com
Players Region
Players Grade
Playing Jersey Size
Playing Shorts Size
Polo Shirt Size
Training Shirt Size
Training Shorts Size
Supporters Polo Shirt $40 (add to Registration Fee)
Tax Incl
Supporters Polo Shirt $40 (add to Registration Fee)
Tax Incl
EMERGENCY CONTACT DETAILS

All Players Require an Emergency Contact
Contact Name

First NameLast Name
Contact Number
Please enter a valid phone number.Format: 0400 000 000.
Contact Email
Use previous email address
Players Recent Injuries or Current Medical Conditions
Recent Injury from 2025
TERMS & CONDITIONS

2026 Registration

Playing Kit (Socks, Shorts, Jersey)

Training Gear (Shorts, Shirt)

Regional Polo Shirt

$250 AUD Quantity

2026 Supporters Shirt

Regional Support Team -

Please Make Sure Your Item Is Added

$40 AUD Quantity
Item subtotal:

Total

Credit Card

Afterpay

RLSQ 2026 - Registration Closes Monday 22 June