WESTS MAGPIES 2015 JUNIOR REPRESENTATIVE APPLICATION FORM

Date: Saturday 11
th
of October Kirkham Park, Camden
Harold Matthews or SG Ball
Name
Date of Birth
Address


Mobile
Email
Current Club
Age Group & Division (in 2014)
School
Occupation
Representative History 2014:

2013:

Preferred Positions 1
st
:

2
nd
:

Player Manager Name:

Contact Number:

I hereby acknowledge that the Western Suburbs Magpies Rugby League Football Club accepts no
liability for injuries sustained during trial matches.

Signature:

(If under 18 years)
Guardian Name:

Signature

Please return nomination forms to Wests Magpies via:
Email development@westsmagpies.com.au
Applications close 5pm Tuesday 7
th
of October Trial Times and Teams will be posted on our website
www.westsmagpies.com.au on Thursday 9
th
of October.
For more information email development@westsmagpies.com.au