School Holiday Football Camp - Player Registration Form

Use this form for payments by Direct Debit or Cash

Player Name

First
Last

Date of Birth

## -
## -
####

Age Group

School Holiday Camp Week: Mon 15th - Wed 17th April '13
Please accept your acknowledgement.

Club
The Football Camp is open to all players internally and externally. Please indicate below:

SU58FC Registered Player
SUJFC Registered Player
Other Registered Player

Parent 1 Name

First
Last

Parent 2 Name

First
Last

Address

Street Address
Street Address Line 2
City
State
Postal / Zip Code
Country

Home Phone

## -
#### -
####

Mobile Phone

#### -
### -
###

Account Details for Direct Debit

Account Name: Sydney United 58 Football Club Ltd

BSB: 032270

Account Number: 313740

Please reference Age Group and Player Surname

Price: $120.00