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Nomination - Individual


For O40s & O50s - Must be submitted by 27th April 2012.
For 045s & O55s - Must be submitted by 1st  June 2012
 
LEGEND
Please note the asterisk beside the boxes down the form relate to the following information .
 
* Nominating For:
Tick one only - submit a separate form for each age division you are nominating for. (Eligibilty: eg. for 40+ must have turned 40 by 31 Dec 2012. For 45+ must have turned 45 by 31 December 2012 etc)
 
** 2012 State Championships Playing Particulars - This is for the State Championships indicating which team you are playing for and preferred team position.

*** Please list major achievements and particulars of your recent playing career (indicate year selected)
 
**** I have read and understood the 'Hockey Queensland Nomination Details' form as supplied by my Association and I agree to the condition of selection etc determined by Hockey Queensland. Tick the 'Yes I agree' box or 'No I don't agree' box marked with ****
 
  
 
 

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Postal Address -  c/ The Secretary, 14 Laidley Creek West Road, Laidley Queensland 4341 Australia