DARWIN CITY V SOUTHERN HEAT SENIOR WOMENS TRIAL GAME
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
DOB
-
Month
-
Day
Year
Date
Club
*
Playing Position
*
Please Select
Wing
Fullback
Centre
Half Back
5/8
2nd Row
Lock
Front Row
Hooker
Utility
Team Registering For(Please note: your club team will be aligned to either City or Southern Heat. Please register for the team your club has been allocated to.)
Darwin City (Brothers, Nightcliff Dragons , South Darwin)
Southern Heat (Litchfield Bears, Northern Sharks, Palmerston Raiders)
Register
Should be Empty: