EmailMe Form - NetSetGO Independent Centre Expression of Interest

Centre Name *
ie School, Recreation Centre etc
Centre Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Closest Netball Association Name
If known
Coordinator Name *
First Last
Point of contact
Coordinator Email *
Coordinator Phone *
Program Details
Nominated Coach Name *
First Last
Program Online Registration Date *
DD / MM / YYYY
Program Start Date *
DD / MM / YYYY
Program End Date *
DD / MM / YYYY
Program Day of the Week *
Monday
Tuesday
Wednesday
Thursday
Friday
Program Start Time *
Program Cost $
(min $62.30)
Participant Number Registration Limit
If applicable
Description
If applicable