NSW Tertiary Student Rugby League

TERTIARY LEAGUE NETWORK:

REPRESENTATIVE

CITY V COUNTRY

NSW STUDENTS REP.

NSW TERTIARY REP.

NSW COACHING STAFF.

It is important that you fill in as much information as possible when registering for NSW team selection.

PERSONAL DETAILS
First Name:
Last Name:
Date of Birth:

CONTACT DETAILS
Address:
Suburb:
Postcode:

Contact Number:
Mobile Phone:
Email Address:

TERTIARY DETAILS
What type of Tertiary institute are you currently attending?	University TAFE Other
What is the name of the institute?
What Course are you currently doing?
What is your Student ID Number:

PLAYING INFORMATION
What team are you currently playing for?
What competition does that team play in?
What position(s) do you prefer to play?

2008 PARTNERS