MID HILLS NETBALL ASSOCIATION INC
Annual Carnival on Sunday 24th May 2015
REGISTRATION FORM
Office Use Only:
Ref No.:…………….
Date received:
……………………
Form can be completed electronically and emailed, if printed PLEASE WRITE CLEARLY
Return form to: MHNA Carnival Committee P.O. Box 438, WOODSIDE SA 5244
OR email [email protected]
Enquiries: 0412 570 336
Team Contact Details
Name of Association or Club
Contact person
Phone Number
Email (to confirm registration)
If paying by Direct Deposit –Please provide Receipt number: 
Umpire Contact Details
Umpire Contact 1DPH
Team Registration/s
Grade
Select from drop down list
or print clearly
11, 13,15,17 & U or Senior
 
Team nominations will NOT be accepted if Umpire details are not provided
Phone Number
At what level does the team usually play
Club Team
Assoc
Div
Rep Team
Umpire Name
Select grade
Select grade
Select grade
Select grade
Select grade
Select grade
Select grade
Select grade
Select grade
Div 2
Example only: 11 and Under
Registration Fee:
$50 per team (includes gst)
Total Registration fee payable is $
Payment Options:
Cheque/Money
Electronic transfer
Maxine McGregor
for
team(s).
Payable to Mid Hills Netball Association and MUST be included with registration form.
Reference must include “CC” plus Team/Association name and number of teams
(eg CC Redback x6)
Receipt number must be included in Team contact details above.
BSB
015-621 (ANZ Lobethal)
Account number
7220 04492
Account name
Mid Hills Netball Association Inc.
Payment must be received before confirmation of registration can be provided.
th
Closing Date 15 May 2015
To help us process your form as quickly as possible complete electronically or please write clearly
NOTE: Please make sure your umpire/s are aware of the following: During minor rounds Umpires will umpire the team they are nominated for.
FINALS: Umpires are required to stay if their team is in the Semi or Grand Final rounds.
Please ensure umpires are of the appropriate standard for the grade they are umpiring.