over-70-representative-registration

2027 Over 70 Representative - Registration

Please answer all questions and send the form by clicking on the Submit button at the bottom

Name

Club

Select a Club

Contact Email

Contact Phone Number

Date of Birth

Please advise which applies to you

I am a NZ Citizen I am a Permanent Resident of NZ

Please confirm the following

I am able to fund my travel and accommodation costs I understand the Selectors decisions are final I agree to abide by the PNZ player code of conduct

Payment of registration fee ($50) to be made by direct credit to PNZ account 02 0772 0018366 00
Note: Please put your Surname & Initials in the Reference field and Over 70 in the Code field

Date Selection fee paid