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Senior Registration Form - Northern Stars VC
This Registration Form is for players at or over the age of 18 as at 31/12/20 ONLY. If you are under 18 as at 31/12/20 please use the alternate Junior Membership Form at
https://forms.gle/Cw7fo8nFgm87aY45A
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First Name
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Your answer
Surname
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Your answer
Gender
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Male
Female
Date of Birth
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MM
/
DD
/
YYYY
Age (as at 31/12/20)
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Your answer
Email Address
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Your answer
Do you have a medical condition/allergies that require medication or any relevant current injuries?
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If yes, please provide details and action required below
Yes
No
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Residential Address
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Suburb
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Postcode
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Your answer
Mobile Phone No.
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Your answer
Emergency Contact Name
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Your answer
Emergency Contact Relationship
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Your answer
Emergency Contact Number
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Your answer
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