SUHA Registration

First Name:*

Surname:*

Email*

Invoice and club emails will be sent to this address.

Phone (Home)

Phone (Business)

Phone (Mobile)

Date of Birth*

Gender

2016 Playing club*

2016 Winter Team for your club*

Why do you want to be part of the Southern United Hockey Academy

Are you a field player or goalie?*

I am a part of the Hockey Victoria Academy

Address (No./Street)*

Address (Suburb)*

Address (Postcode)*

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 2 Name

Parent 2 Email

Club emails will also be sent to this address, invoice will NOT be sent to this address.

Parent 2 Phone #

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.

Playing with Southern United Hockey Club*

If accepted into the Southern United Hockey Academy I will play for Southern United Hockey Club in 2017

Payment*

If accepted to Southern United Hockey Academy I will pay the $240 ($100 if HV Academy)