Do you prefer to Manage Men's or Womens Teams?* Please select... Men Women Either

Please indicate which team you would prefer to Manage.(please note this is a non player role)*

Please indicate which other age groups you would be interested in Managing (max 3)* Max 255 characters

If you are not appointed to your chosen age group(s) will you accept a position in a different age group?* Please select... Yes No

Additional Notes Max 255 characters

Referee #1 Name*

Referee #1 email address*

Referees #1 State Association*

Referee #1 Phone Number( please advise referees of this)*

Referee #2 Name*

Referee #2 email address*

Referees #2 State Association*

Referee #2 Phone Number( please advise referees of this)*

Please indicate which representative grades you have managed* Max 255 characters

Upload Hockey CV with Management experience

Are you a current Australian Citizen* Please select... Yes No