REGISTRATION Border Indoor Hockey warmly welcomes all players, from experienced players to beginners, no matter what age. Register now using the form below: Registration FormFirst Name Last Name Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweEmail Phone Male / Female MaleFemaleDate of Birth Hockey Victoria Number (if known) Highest level of Hockey (winter competition) you have played in 2018 ? Team - Competition Selection JDK Management Competition -10th Oct - 19th Dec 2018 Premier (Mixed)Senior MenSenior WomenUnder 12 mixedUnder 15 mixedBiH Mixed Social Competition - 23rd Jan - 13th March 2019 Mixed SeniorsUnder 12's mixedUnder 15's mixedCombined - JDK Management Comp + BiH Social comp. Premier League - mixedSenior MenSenior WomenUnder 15's mixedUnder 12's mixedWho is your winter club? Fee's Fees can be paid in person a week before too the first week of play -- JDK Management Comp = 10th Oct - 19th Dec 2018 $100 (Junior Comp.) $120 (Senior Comp.) ---BiH Mixed Social Comp = 23rd Jan - 13th March 2019 $80 (Junior Comp.) $90 (Senior Comp.) --- COMBINED = Both comps ( Big savings) 18 rounds $160 (Juniors) $190 (Seniors)AgreeDisagreeRules In the event of my/my child's admission as a member, I/my child agree to be bound by the rules of the Border Indoor Hockey for the period of membership.AgreeDisagreePhotographs I give permission for Photographs of myself/my child to appear on the www.borderindoorhockey.com.au website or in other forms of media releases & to include my name.AgreeDisagreeUniform *I acknowledge that my uniform stays the property of Border Indoor Hockey. A levy is included as part of my registration fee’s. I am required to return my uniform at the end of the season competition.YesCode of Conduct I/and or my child have read & understood & agree to abide by the "Code of Conduct" of Border Indoor Hockey. - All members & supporters of Border Indoor Hockey shall conduct themselves in the spirit of good sportsmanship & show respect to teammates, officials & spectators at all time.AgreeDisagreeEmergency Contact Person Emergency Contact Person Phone Indoor Help EXPRESSION OF INTEREST: PLAYERS, PARENTS, SPECTATORS & other SUPPORTERS please tick any areas you may be interested in assisting, supporting or becoming involved in, with Border Indoor Hockey.UmpireCoachManagerScore the gameSet upDate Name / Signature Name & Validation of the applicant or guardian/parent (if the applicant is 16 years or under) NAME: SIGNATURE: * Your application is subject to approval by Border Indoor Hockey committeeHealth Statement Please disclose any chronic or recurrent ailments, allergy or a physical condition so that the correct information can be provided to a health official in case of an emergency.Approval Your application is subject to approval by Border Indoor Hockey committee. Wodonga Hockey Club Inc. trading as Border Indoor Hockey VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank: