Senior Men Registration

Personal Information

Name *

First

Last

Preferred Name

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Postal Address (if different from home)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date of Birth *

Are you of Aboriginal or Torres Strait Islander origin? *

No
Yes

Were you or either of your parents born in a country other than Australia? *

Yes
No

If yes, who and where?

I consent to my image being used for Sturt Football Club, SANFL & other media. *

Yes
No

Parent/Guardian/Next of Kin Information

Used to contact family for special events, eg debut milestones and/or in case of emergency

Parent/Guardian/Next of Kin 1 Name *

First

Last

Email *

Phone *

Relationship to You

Parent/Guardian/Next of Kin 1 Occupation

Parent/Guardian/Next of Kin 1 Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent/Guardian/Next of Kin 2 Name

First

Last

Email

Phone

Relationship to You

Parent/Guardian/Next of Kin 2 Occupation

Parent/Guardian/Next of Kin 2 Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Personal Information

Parent/Guardian/Next of Kin Information

Basic Medical

Health Insurance

Football Information

Finance Information