Mens Masters Intrastate Tournament 2013

Sunday 9th June Monday 10th June Tasmanian Hockey Centre

PLAYER NOMINATION FORM

I wish to compete in the Mens Masters Intrastate Tournament

Division One Southern Team Northern Team North-West Team

Division Two Southern Team Northern Team North-West Team

Players Name Phone (home) Email Address Club Team/Grade Preferred Playing Position/s Playing Experience - Club/Regional / State

Date of Birth Phone (mobile)

I am interested in attending a Mens Masters Dinner at the THC on Sunday 9th June I am able to attend regional training I have nominated for selection in a Tasmanian Masters Team Sun 19 May StL 10-12 1202pm O35 / O40 / O45 / O50 O65 / O55 / O60 / Sun 26 May THC

(please circle preferred age group)

Completed nomination forms are to be emailed to: Peter Gaggin (South) pgaggin@philplighton.com.au Jeremy Stebbings (North) jeremystebbings@hotmail.com Cor VanderVlist (North West) cor.vander.vlist@centralcoast.tas.gov.au ; Jason Lynch
jlynch@serve-ag.com.au

Mens Masters Tournament - Nomination Form (version 2013.01)