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 Highest level of Hockey (winter competition) you have played in 2018 ? Teams Select which team you would like to play in for 2018 seasonUnder 12 mixedUnder 15 mixedSenior WomenSenior MenPremierWho is your winter club? Fee's Fees are due before Round 1 - If not paid you will not be covered by the insurance policy. $???? (Junior Comp.) $??? (Senior Comp.) - existing member of a Hockey Albury Wodonga affiliated Clubs $30 extra- if not an existing member of a Hockey Albury Wodonga affiliated Club Note: the additional $30 is a State Victoria requirement, and provides the player access to insurance. Fees can be paid by accessing the Link at the bottom of this form. Alternatively, fee's can be paid in person a week before the competition start date...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.AgreeDisagreeCode 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. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
