Melbourne - IRANZ Camp
Expression of Interest Form
Melbourne IRANZ Camp
Course interested in
Please Select
4 Day - Player (13-15 yrs) - $ 1,770
4 Day - Player (16-17 yrs) - $ 1,770
4 Day - Player (18 yrs, First XV & Club) - $ 1,770
4 Day - Coach (Club & School) - $ 1,770
If you have more than one child please complete another form.
Name
*
First Name
Last Name
Player Email
*
PLEAES CHECK YOUR SPAM FOLDERS IF YOU ARE USING A GMAIL or HOTMAIL EMAIL if you can please use an alternate mail to gmail or hotmail
Player Mobile
*
-
Country Code
-
Area Code
Phone Number
Player Date of Birth
*
-
Day
-
Month
Year
Date
Age
*
Gender
*
Please Select
Male
Female
Prefer not to say
Weight (Kg)
*
Height (cm)
*
Affiliated Club / School / Union
*
Preferred Position :
*
Please Select
1 Loose Head Prop
2 Hooker
3 Tight head Prop
4 Number 4 Lock
5 Number 5 Lock
6 Blindside Flanker
7 Openside Flanker
8 Number 8
9 Scrum half
10 Fly Half
11 Left wing
12. Inside Centre
13. Outside Centre
14 Right wing
15 Full back
Second Preferred Position :
*
Please Select
1 Loose Head Prop
2 Hooker
3 Tight head Prop
4 Number 4 Lock
5 Number 5 Lock
6 Blindside Flanker
7 Openside Flanker
8 Number 8
9 Scrum half
10 Fly Half
11 Left wing
12. Inside Centre
13. Outside Centre
14 Right wing
15 Full back
Parent & Guardian Details
Name
*
First Name
Last Name
Parent/Guardian Mobile
*
-
Area Code
Phone Number
Parent/Guardian Email
*
PLEAES CHECK YOUR SPAM FOLDERS IF YOU ARE USING A GMAIL or HOTMAIL EMAIL if you can please use an alternate mail to gmail or hotmail
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By registering for this event, I accept the Terms & Conditions
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