Team Nomination

 

 

Team Details

Team Name

Division Mens Mixed

Preferred Night Monday Wednesday

Preferred Grade A B C D E

Previous Experience

Has the majority of your team played before? Yes No

Which competition and grade did you play in and where did you finish?

If you played in the last Unitouch season, what was your team name?

Contact Details

Primary Contact Person

Name

Email

Address

Postcode

Contact numbers

Home

Work

Mobile

(Please provide at least one contact number)

Seconday Contact Person

Name

Email

Address

Postcode

Contact numbers

Home

Work

Mobile

Payment Details

Total

$990.00

Available Discount

$50.00 (if fees are paid in full by 6pm Friday prior to start of the season)

Please note, a minimum payment of $400 must accompany your team nomination. Balance of fees due by the 3rd week of fixtures.

Payment amount

Payment method Electronic Funds Transfer Cheque or Money Order Credit Card

Acc Name: University of QLD Touch Club
Acc No: 00904344
BSB: 06 4008
(Please type your team name in the description field and print off a copy of the confirmation receipt.)

Made payable to "University of QLD Touch Club" and
mail to "The Administrator Unitouch PO Box 297 Toowong QLD 4066"

(VISA or MasterCard accepted only)
Please fill in the details below or phone the Administrator on 0418 731 293 to advise your cc details.

Credit Card Details

Card Type VISA MasterCard

Card Name

Card Number

Card Expiry Month 01 02 03 04 05 06 07 08 09 10 11 12

Card Expiry Year 2011 2012 2013 2014 2015 2016

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