Referee's Shield 2019 Team Registration
Club (*)

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Club contact name (eg Secetary/President) (*)

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Club contact email (*)

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Team contact (captain/coach/manager) (*)

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Team phone number (*)

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Team contact email (*)

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We are able to provide a field for use in the Referee's Shield Competition on:




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Field name

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Field restrictions

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Competition (*)




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To help us create groups, where did your team play last season (2018)?

2018 Age group

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2018 division (*)

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2018 Division Placing

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Players

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I, as a representative on behalf of my team and club, confirm that all players listed are eligible and registered to play with QCSA in the 2019 competition. I understand that any player not registered to play with QCSA in 2019, and not listed in this form is not eligible to play in the 2019 Referee's Shield. I understand my team submission is not accepted until full payment of $140 (including GST) is received. I understand the entry fee is non-refundable in the event of forfeits, abandoned games (for weather or otherwise), or other unforeseen reasons.

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