Masters Team Nomination

If you wish to nominate for the 2012 Queensland Masters Team please complete the following on-line nomination form.

First Name: * First Name:

Please enter your first name.

Last Name: * Last Name:

Please enter your last name.

Rowing Club: * Rowing Club:

Please enter your Rowing Club's name.

Gender: * Gender

Please enter your gender in the text box.

Date of Birth: *

Please enter your date of birth in dd/mm/yyyy

Age: * Age:

What is your current age as of 31st December 2011.

Email: *

Please type in your email address, ensuring your email is correct otherwise you will not receive any communication.

Mobile No.: * Mobile No.

Please enter in your mobile phone number.

Home Phone: * Home Phone

Please enter in your home phone number here.

Sweep: * Sweep (Yes/No)

Please type Yes/ No if you are vying for the Sweep boats.

Scull: * Scull (yes/no)

Please enter yes/ no if you are vying for selection in a sculling boat.

Coach: * Coach (yes/no)

Please enter yes / no if you are vying for coach selection.

Coxswain: * Coxswain (yes/no)

Please enter yes / no if you are vying for a coxswain position for the 2010 Masters State team.

Zootie Size: * Zootie Size

Please enter your zootie size (simply oarsome).

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