ࡱ > q t p } bjbj 4> i T T 8 $ * * * * * * * * , ;/ * * 4 * 9 9 9 F * 9 * 9 9 ' h ) @ F( ~* * 0 * V( / B / ) ) / .) P 9 * * 9 * / T ] : Under 18 Girls State Team Perth April 21st-27th Registration of Interest On receiving selection advice All selected players will be required to pay: Coaching & Management Levy of $120 (non refundable) Includes training top Coaching & Management Levy (non-refundable)$120 Senior Behaviour Bond (refundable)$100 Uniform Bond (refundable)$80Uniform Hire$20AccommodationTBAFlightsTBAPetrol/Car HireTBABoathouse Jacket$150Team Equipment$25Team Photo$25Championship DinnerTBAPiping Shrike Polo (Compulsory Item)$30LSA Track Pants$30LSA Polo$32LSA Shorts Please note, the Coaching & Management Levy is non-refundable should a player withdraw from the team at short notice prior to departure. Please complete this section and return to tiffany.smith@lacrossesa.com.au Name: ............................................................................................................................................................... Address:............................................................................................................................................................. Suburb:............................................................................... Post Code:........................................................ Phone No:.................................................................... Mobile:..................................................................... Email:................................................................................................................................................................. DOB:............................................................... Age at 1st January 2013:.............................................. Club:................................................................... Playing Position:.................................................................... Parents/Guardian Name:................................................................................................................................... Parents/Guardian Email:.................................................................................................................................... Parents/Guardian Mobile:.................................................................................................................................. % & ( * + - / 0 1 2 3 L i j B C K O a Žxllb h_