Bruins Junior Representative Trial Registration Form

Number of Players Registering

Age Group Trialing For

Gender*

Player First name*

Player Last name*

Date of Birth

Medical Conditions/ Special notes

2021 Representative Player*

At which Association

Bankstown Local Comp Team Name

Bankstown Local Competition Day*

Parent/Guardian Contact Name*

Parent/Guardian Contact Number*

Email*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Total

$ 0.00

Credit Card

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