2019 Pesle Dicker Memorial Shield Under 9s Gala Day - Expression of Interest Form
All teams registering their interest should read the terms and conditions at http://bit.ly/pesledicker before completing this form.

The gala day will be held on Saturday 14th September 2019 at Leonay Oval from 9am. The contact person from each team will be emailed a nomination form to complete after registering your expression of interest. The nomination form will ask you for your team's player names, birth dates and NRLID numbers as well as coaching staff names, birth dates, qualifications and NRLID numbers.

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Email *
ABOUT YOUR TEAM
1. Which Junior League is your team associated with? example - Penrith Juniors / Parramatta Juniors *
2. Which club is your team associated with? example - Penrith Waratahs / Berala Bears *
3. Which division does your team play in for the 2019 season? example - Division 1 / Division 5 *
4. How many players will play in your team for the gala day? example - 11 players / 15 players (Max 15 players per team) *
CONTACT PERSON FOR YOUR TEAM
All required paperwork will be emailed to this person, so please ensure your email is correct.
5. Name of the contact person for this registration? *
6. What is the contact person's email address? *
7. What is the contact person's phone number? *
ACKNOWLEDGEMENTS
Do you acknowledge that all players and coaching staff participating in the gala day are registered for the 2019 season? *
Do you acknowledge that no BBQs or alcohol will be brought into Leonay Oval, or used/consumed by officials or supporters associated with your team? *
Do you acknowledge that your team will pay the entry fee of $50 and complete all required paperwork emailed to you by 23rd August 2019? *
Thank you for your interest in our U9s Pesle Dicker Memorial Shield Gala Day, all required paperwork will be emailed to you within 48 hours of completing this form.
A copy of your responses will be emailed to the address you provided.
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