Seniors Register Online

(Red Questions are compulsary)

Your Name :

Partners Name:

Relevant Phone Numbers:

Home: Work:

Mobile: Fax:

Do you wish to subscribe to the Clubs Magpie Newsletter: Yes No 
Grade Played Last Year:

With which Hockey Club :

Occupation :

Employer :

Fulltime Student No. :  Yes No

Uni/School :

New Player : Yes No 

How did you hear about the Fremantle Hockey Club? :

I will be paying my fees via Direct Debit online facilities : Yes No 

PREVIOUS MEMBERS - Details on Courses and Interest in Helping the Club

Have you completed any training courses in: (Please give details, levels and dates)
Please select, add or remove from list below..... Coaching - Level Attained & Date First Aid - Level Attained & Date Additional Courses - Levels & Dates.

Are you interested in helping the club with either of the following:

Please select, add or remove from list below..... Junior/Senior Coaching, Sponsorship, Fundraising, Helping out the Social Committee, Umpiring, Other - please provide details please give details.

PLEASE INPUT THE FOLLOWING CODE TO SEND THIS FORM:(stops spam)