MID HILLS NETBALL ASSOCIATION INC
Annual Carnival on Sunday 21stMay 2017
REGISTRATION FORM
Form can be completed electronically and emailed, if printed PLEASE WRITE CLEARLY
Return form to: MHNA Carnival Committee P.O. Box 438, WOODSIDE SA 5244
OR email nquiries: 0418 816 684
Name of Association or Club
Contact person / Phone Number
Email (to confirm registration)
When paying by Direct Deposit –Please provide Receipt number:
Umpire Contact Details / Team nominations will NOT be accepted if Umpire details are not provided
Umpire Contact Name / Phone Number
Team Registration/s
Grade
Select from drop down list
or print clearly
11, 13,15,17 & U or Senior / Select if Club or Association Team and Div preferred.
(Div allocated will be dependent on number of teams registered and program allocation) / Umpire Name
Team registration will not be confirmed until an Umpire name is provided for each team listed.
Club Team
Div / Assoc /Rep Team
Div
Select Grade.11 and Under13 and Under15 and Under17 and UnderSenior
Select Grade.11 and Under13 and Under15 and Under17 and UnderSenior
Select Grade.11 and Under13 and Under15 and Under17 and UnderSenior
Select Grade.11 and Under13 and Under15 and Under17 and UnderSenior
Select Grade.11 and Under13 and Under15 and Under17 and UnderSenior
Select Grade.11 and Under13 and Under15 and Under17 and UnderSenior
Select Grade.11 and Under13 and Under15 and Under17 and UnderSenior
Select Grade.11 and Under13 and Under15 and Under17 and UnderSenior
Select Grade.11 and Under13 and Under15 and Under17 and UnderSenior
Example only: 11 and Under / Div 2 / Maxine McGregor
Registration Fee: $50 per team (includes gst)
Total Registration feepayable is $. for . team(s).
Payment Options:
Cheque/Money Payable to Mid Hills Netball Association andMUST be included with registration form.
Electronic transferReference must include “CC” plus Team/Association name and number of teams
(eg CC Redbackx6)
Receipt number must be included in Team contact details above.
BSB015-621 (ANZ Lobethal)
Account number 7220 04492
Account nameMid Hills Netball Association Inc.
Payment must be received before confirmation of registration can be provided.
Closing Date 12thMay 2017
To help us process your form as quickly as possible complete electronically or please write clearly
NOTE: Please make sure your umpire/s are aware of the following: During minor rounds Umpires will umpire the team they are nominated for.
FINALS: Umpires are required to stay if their team is in the Semi or Grand Final rounds.
Please ensure umpires are of the appropriate standard for the grade they are umpiring.