EOI : 2016 EOI MasterClass Series

2018 Elite Camp Program

Please fill in the player registration form. Once completed, submitted and deposit received, you will become eligible for squad selection.

• Name*
  First Last
• Address*
  Street Address City ZIP / Postal Code
• Date of Birth*
  MM123456789101112

  DD12345678910111213141516171819202122232425262728293031

  YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
• Select which player registration package you will pursue*
  1 x Player registration ($495)1 x Player regsitration INCLUDING Player Sponsorship 'Basic' Package ($495)1 x Player regsitration INCLUDING Player Sponsorship 'Advanced' Package ($699)1 x Player registration INCLUDING Player Sponsorship 'Major' Package ($1,950)No, unfortunately I will not be registering for this year's Elite Camp
• Would you be kind enough to provide more details as why this year's Elite Camp is not for you.
• Name of Parent / Guardian*
• Parent / Guardian Phone No. (Mobile)*
• Parent / Guardian email address*
• Player email address (Leave blank if none)
• Player phone No. (Leave blank if none)
• 2018 Local Club*
• Any medical conditions / allergies*
• I have read and understand the information outlined below*
  1) To become eligible for selection a $200 deposit will be required. 2) You will be issued an invoice for the deposit, upon submission of this form 3) If you are not selected but wish to continue in the training squad, you will not be reimbursed the $200 4) If you are NOT selected in the playing squad and do NOT wish to continue with the training squad, a full refund of your $200 will be issued. 5) The $200 deposit needs to be paid before Monday 16th April
  • YES
• Total
  ONLY payable should you be selected in the representative team
  $ 0.00