EmailMe Form - TWO DAY SCHOOL HOLIDAY CLINIC

Player's Name: *
First Last
Email Address: *
Phone: *
### - ### - ####
Parent/Guardian's Name: *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Player's DOB:
DD / MM / YYYY
Please list the last TWO clubs you were registered with:

Club One:

Club Two:
Where did you hear about the Illawarra Stingrays Clinic?
Will you be attending both days?
Yes
No
Message

Club One:
Club Two: