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2018 Samsung PremierLeague Team Registration Form LICENSEE: CONTACTS Primary contact for all correspondence Secondary contact for all correspondence Name: Name: Email: Phone: Email: Phone: Media Contact Name: Email: Phone: BENCH OFFICIALS Bench Officials must hold a current State Level accreditation and may be allocated as required.(please refer to clause 4.4 of the Premier League Competition Regulations. Bench Official 1 Bench Official 2 Name: Name: Email: Phone: Email: Phone: Accreditation: Accreditation: TEAM REGISTRATION DETAILS I, (Full Name) on behalf of (Licensee) certify that the information provided in relation to all players’ registration details have been checked with both the player and other relevant Netball NSW documentation and that all players have signed an official Player Registration Form, and a copy has been provided to Netball NSW. I further certify that all players and officials are current financial members of Netball NSW or relevant State or Territory. WORKING WITH CHILDREN CHECK DECLARATION I can confirm that I, (Full Name) on behalf of (Licensee) have verified all WWCC numbers for all coaches, managers and any other supporting members (where a WWCC is required) involved with teams I am entering into this competition. Sign declaration: Team Registration forms along with player registration form must be returned via email no later than 5pm Wednesday 4 April 2018 to the Netball NSW Competitions Manager: [email protected] Office Use Only Application Received: Email Date Received: Acknowledgement Sent: Email Date Sent: 2018 Premier League Team Registration Form Page 1 of 3

2018 Samsung Premier League Team Registration Form · 2018 Samsung Premier League Team Registration Form LICENSEE: CONTACTS . Primary contact for all correspondence

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Page 1: 2018 Samsung Premier League Team Registration Form · 2018 Samsung Premier League Team Registration Form LICENSEE: CONTACTS . Primary contact for all correspondence

2018 Samsung Premier League Team Registration Form

LICENSEE:

CONTACTS Primary contact for all correspondence Secondary contact for all correspondence

Name: Name:

Email: Phone: Email: Phone:

Media Contact

Name:

Email: Phone:

BENCH OFFICIALS Bench Officials must hold a current State Level accreditation and may be allocated as required.(please refer to clause 4.4 of the Premier League Competition Regulations.

Bench Official 1 Bench Official 2

Name: Name:

Email: Phone: Email: Phone:

Accreditation: Accreditation:

TEAM REGISTRATION DETAILS

I, (Full Name) on behalf of (Licensee) certify that the information provided in relation to all players’ registration details have been checked with both the player and other relevant Netball NSW documentation and that all players have signed an official Player Registration Form, and a copy has been provided to Netball NSW.

I further certify that all players and officials are current financial members of Netball NSW or relevant State or Territory.

WORKING WITH CHILDREN CHECK DECLARATION

I can confirm that I, (Full Name) on behalf of (Licensee) have verified all WWCC numbers for all coaches, managers and any other supporting members (where a WWCC is required) involved with teams I am entering into this competition.

Sign declaration:

Team Registration forms along with player registration form must be returned via email no later than 5pm Wednesday 4 April 2018 to the Netball NSW Competitions Manager: [email protected]

Office Use Only Application Received: Email Date Received: Acknowledgement Sent: Email Date Sent:

2018 Premier League Team Registration Form Page 1 of 3

Page 2: 2018 Samsung Premier League Team Registration Form · 2018 Samsung Premier League Team Registration Form LICENSEE: CONTACTS . Primary contact for all correspondence

2018 Samsung Premier League Team Registration Form

OPEN DIVISION

NAMES TO BE RECORDED ON TEAM PLAYER LIST

Players Name My Netball No. DOB Metro League Association Player Registration

Form received (NNSW use only)

Team Management Name My Netball No. Accreditation / Qualification

Head Coach

Assistant Coach

Manager

Other Primary Care/Physiotherapist (Please refer to clause 8.5 of the Premier League Competition Regulations which refers to sub-contractors).

Company name Primary Contact

Email Phone

2018 Premier League Team Registration Form Page 2 of 3

Premier League Team Name:

Page 3: 2018 Samsung Premier League Team Registration Form · 2018 Samsung Premier League Team Registration Form LICENSEE: CONTACTS . Primary contact for all correspondence

2018 Samsung Premier League Team Registration Form

Under 20s DIVISION

NAMES TO BE RECORDED ON THE U20s TEAM PLAYER LIST

Players Name My Netball No. DOB Metro League Association Player Registration

Form received (NNSW use only)

Team Management Name My Netball No. Accreditation / Qualification

Head Coach

Assistant Coach

Manager

Other

Primary Care/Physiotherapist (Please refer to clause 8.5 of the Premier League Competition Regulations which refers to sub-contractors).

Company name Primary Contact

Email Phone

Premier League Team Registration Form Page 3 of 3

Premier League Team Name: