What position/s are you nominating for?  You may select more than one*

Please select your preferred age groups/panel, final determination by HAMC committee*

If you have other responsibilities during the tournament, please indicate your other role/s and age group/s, e.g. coach (age), umpire, etc. If none, indicate Nil.*

If you are not appointed to your chosen age group/s are you interested in being considered for other selector opportunities?*

1st Referee Name*

1st Referee email address*

1st Referee Role in Hockey*

2nd Referee Name*

2nd Referee email address*

2nd Referee Role in Hockey*

Please indicate recent experience in the position* Max 255 characters

Please add any additional information that you want to be considered. Max 255 characters

Please indicate which Association and State you are from ?* Max 255 characters

Are you a currently selected as a Australian Spirits or Southern Cross Coach or selector?*

Please upload Hockey CV with Relevant experience