Representative Selector Nomination Form

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This form is to be completed for the nomination to be a representative selector. Selectors must be available for selection and squad trials.

Applications will be considered by the Management Committee.

Email *

Your Name *

Mobile Number *

Address *

Date of Birth *

YYYY

Working with Children Number *

Registered Club *

Selector Qualification *

Select for Success

Other:

Age I cannot select on

11 years

12 years

13 years

14 years

15 years

17 years

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Other relevant Information for consideration

A copy of your responses will be emailed to the address you provided.

Submit

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