Registration Form 2015 Registration Form 2015 New SUHC Members I am a new member Today's Date* Day Month Year First Name:* Surname:* Email* Invoice and club emails will be sent to this address.Phone (Home) Phone (Business) Phone (Mobile) Date of Birth* DD slash MM slash YYYY Gender M F Address (No./Street)* Address (Suburb)* Address (Postcode)* Pricing All playing members MUST register with Hockey Victoria and pay the additional - $45 - for those over 18 or - $35 - for those under 18 Category Men Womens Masters Student playing Men's Student playing Women's Juniors U12 - U18 Juniors U10 Intra Club Gold Non-Playing Non-Playing Life Men* Winter Playing Fees = $525.00 Winter Goalie Fee (own gear) = $185.00 *If you choose the Winter Goalie Fee option, please un-tick the Winter Playing Fee as this is not charged if you are a goalie. Women* Winter Playing Fees = $525.00 Winter Goalie Fee (own gear) = $185.00*If you choose the Winter Goalie Fee option, please un-tick the Winter Playing Fee as this is not charged if you are a goalie. Masters* Winter Playing Fees = $525.00 Winter Goalie Fee (own gear) = $185.00 *If you choose the Winter Goalie Fee option, please un-tick the Winter Playing Fee as this is not charged if you are a goalie. Juniors* Winter Playing Fees = $255.00 Winter Goalie Fee (own gear) = $185.00 *If you choose the Winter Goalie Fee option, please un-tick the Winter Playing Fee as this is not charged if you are a goalie. Family Discount = -$15.00 discount applicable to the 3rd and subsequent playing members from each family. Student playing Men's* Winter Playing Fees = $355.00 Winter Goalie Fee (own gear) = $185.00 *If you choose the Winter Goalie Fee option, please un-tick the Winter Playing Fee as this is not charged if you are a goalie. Family Discount = -$15.00 discount applicable to the 3rd and subsequent playing members from each family. Student playing Women's* Winter Playing Fees = $355.00 Winter Goalie Fee (own gear) = $185.00 *If you choose the Winter Goalie Fee option, please un-tick the Winter Playing Fee as this is not charged if you are a goalie. Family Discount = -$15.00 discount applicable to the 3rd and subsequent playing members from each family. Umpiring Fee* Umpiring Fee = $30 The $30 umpiring surcharge will be refunded if player umpires a men's game as requested.Life* Life Member Playing Fee = $100.00 U/10* Winter Playing Fees = $140.00 Family Discount = -$15.00 discount applicable to the 3rd and subsequent playing members from each family. Intra Club Hockey* Term 2 = $35.00 Term 3 = $35.00 You must register with Hockey Victoria and pay the $35 registration for insurance purposes. This is only needed once for the year.Non-Playing* Annual Membership = $30.00 Gold Non-Playing* Annual Membership = $100.00 Secondary Category* N/A Junior playing Mens = $130.00 Junior playing Womens = $130.00 Senior playing Masters = $130.00 Masters playing Seniors = $130.00 Total $ 0.00 *Payment instructions will be emailed to you once the form has been submitted.Occupation If Under 18If player is under 18, please fill in belowSchool/College you attend* Parent 1 Parent 1 Email Club emails will also be sent to this address, invoice will NOT be sent to this address.Parent 1 Phone #Parent 1 Occupation Parent 2 Name Parent 2 Email Address Club emails will also be sent to this address, invoice will NOT be sent to this address.Parent 2 Phone #Parent 2 Occupation Agreements.Terms* I hereby agree to be bound by the Rules, By-Laws and Regulations of the Southern United Hockey Club, Inc as amended by the Committee of Management from time to time. Click here for full details Photos* I consent to Southern United Hockey Club and its agents recording images of me at club events, training and games for promotional purposes. I consent to these images being used in promotional material including on the world wide web or any other media. HV registration* I will register with Hockey Victoria and pay the $35(u18) or $45(over 18) Umpiring:* I agree to umpire one or more games as required by the SUHC Hockey Club. Refer Umpiring Section on website for more details.
