Youth & Senior Futsal State Team Trial Registration Form
First Name
*
Surname
*
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
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31
Day
Please select a year
2026
2025
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Year
What will your age be at 31/12/2009?
*
Please Select
17
18
19
20
21
22
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100
Gender
*
Male
Female
Email (All correspondence will be sent directly to this address)
*
Re-type email address
*
Address
*
Suburb
*
Postcode
*
Phone Number (BH)
*
Mobile
*
Is this the first time you've trialled for a Futsal State team?
*
Yes
No
What position are you trialling for?
*
Goalkeeper
Outfield Player
Please specify if you are/were in any of the following programs
*
Futsal State team (Jan 2009 Tour)
Summer League
W-League
NTC
Vikings Futsal
None of the above
Do you play in a Futsal competition?
Yes
No
If Yes, please specify what competition you play in?
What age category do you play in?
Do you play for an outdoor Football Club?
*
Yes
No
If Yes, please specify what Club you play for?
What age category do you play in?
Submit
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