NOMINATION FORM

Tasmanian Mens Masters Team 2013 Australian Masters Championships Sydney, NSW - October 2013 September

Players wishing to be considered for selection in a 2013 Tasmanian Mens Masters Team must complete the attached nomination form and return by Wednesday 12th June 2013, with payment of the nomination fee of $200 to Hockey Tasmania Finance Officer, PO Box 96 New Town TAS 7008; or by email to accounts@hockeytas.com.au. Nomination forms are also available on the Hockey Tasmania Website www.hockeytas.com.au Name Postal Address Phone (h) Email Address Club I wish to nominate as a player in a Tasmanian Mens Masters Team (please circle your preferred age group) I wish to nominate as Manager of a Tasmanian Mens Masters Team (please circle your preferred age group) I have completed a Yes / No Accreditation First Aid Course I wish to nominate as Coach of a Tasmanian Mens Masters Team
(please circle your preferred age group- you may nominate as a playing coach)

Date of Birth State Phone (m)

(essential as invoices will be sent to this email address-please print clearly)

Post Code

O35 / O40 / O45 / O50 / O55/ O60 / O65 O35 / O40 / O45 / O50 / O55/ O60 / O65 Date of Expiry O35 / O40 / O45 / O50 / O55/ O60 / O65 Year of Accreditati on

HockeyEd / NCAS Coaching Accreditation (please circle current level

of accreditation)

Community / Beginner / Development Level 0 / Level 1 / Level 2

I wish to nominate as a Tasmanian Selector

(please circle your preferred age group - you may not be a selector for your own age group)

O35 / O40 / O45 / O50 / O55/ O60 / O65 O35 / O40 / O45 / O50 / O55/ O60 / O65 Date IN Date OUT

I wish to nominate as an Australian Selector

(please circle your preferred age group - you may not be a selector for your own age group)

No

(please indicate no of people and bedding configuration required eg Q or singles) Names of others with whom you wish to share an apt

Beddin g

I would like HT to organise my accommodation

I require accommodation on the following dates

DIRECT DEBIT (preferred method of payment) Payment of the $200 nomination fee has been made by direct deposit (this fee is refundable, less an administration fee of $25, up to
the end of August 13; after this date a further fee may be deducted to cover any losses incurred by HT on your behalf)

Account Name: Hockey Tasmania Inc BSB: CBA 067-028 Account: 28011822 Send confirming email to: accounts@hockeytas.com.au with Reference: TAS M Masters add players name CHEQUE I enclose payment of nomination fee ($200 cheque payable to Hockey Tasmania Inc CREDIT CARD Visa Credit card # Card holders name
State Masters M Nomination Form & Information Sheet 2013

Please debit $200 to my credit card Mastercard

Expiry date OFFICE USE ONLY Date of payment

Signature Receipt #

I have read the information sheet attached to this nomination form; I understand the commitments related to membership of a Tasmanian Masters team; I undertake to make prompt payment for expenses incurred on my behalf and will ensure full payment is received by Hockey Tasmania no later than the due date set for final payment.

Players Signature:

Date:

INFORMATION SHEET
Tasmanian Mens Masters Teams 2013 Australian Masters Championships Sydney, NSW September - October 2013
The Australian Masters National Championships are scheduled to be held in Sydney from Saturday 21st September Friday 27th September for Over 35s, and from Thursday 26th September Saturday 5th October for all other age groups. Information about the Championships can be found on this website
http://nationalmastershockey.com.au/

Eligible players are invited to nominate for selection in a Tasmanian team the age of eligibility for a team being age as at 31 December 2013. Closing date for player nominations is Wednesday 12th June. The cut-off date for any late nominations is 30th June at which time a decision will be made as to the age groups and number of teams to be entered, following assessment of the total number of nominations received across each age group. Nomination for selection in a Tasmanian team will only be accepted with payment of a nomination fee of $200. This fee is fully refundable (less an administration fee of $25) up to the end of August 2013; after this date a further fee may be deducted to cover any losses
incurred by HT on your behalf.

Hockey Tasmania is also calling for Expressions of Interest for appointment as a Selector and/or Tasmanian team official. Closing date for nomination for selector, coach or manager positions is Wednesday 15th May. Please return completed form with payment to: accounts@hockeytas.com.au or post to Lesley Smith, Hockey Tasmania Finance Officer, PO Box 96 NEW TOWN TAS 7008 The Annual Intrastate Masters Tournament will be held in Hobart on Sunday 9th June Monday 10th June. Please note that the turf bookings shown below, in Launceston on Sunday 19th May and in Hobart on Sunday 26th May, are available for regional trials and/or training for this event. More information will be out soon with details of who is coordinating teams in each region. In addition to airfare and accommodation, an estimate of team costs is provided below. Estimated Cost per Player - Team Expenses HA Team Entry Fee HA Masters Levy Team Vehicle & Fuel (if required) Team Photo Post-Match Drinks $40.00 $15.00 $120.00 $20.00 $40.00 Draft Training & Selections Schedule Mens Masters
Regional Trials North Regional Trials South Intrastate Tournament State Trials - Final State Training South Sun 19 May StL2 10-12 Sun 26 May THC2 12-2pm Sun 9 - Mon 10 June THC Sun 16 June THC2 12-2pm Sun 21 July StL2 10:3012:30

State Masters M Nomination Form & Information Sheet 2013

Post Game Presentations Umpires' Travel & Accommodation Physio Services & Consumables Manager- General Expenses Training & Equipment HT Awards Team Contribution

$14.00 $55.00 $65.00 $5.00 $15.00 $6.00 $395.00

Total

State Training North State Training North State Training North State Training South State Training North State Training South Championship Dates

Sun 21 July THC3 11am1pm Sun 4 Aug StL2 10am-1pm Sun 15 Sept StL2 10:3012:30 Sun 15 Sept THC1 9-11am Sun 21 Sept StL2 9:3011:30am Sun 21 Sept THC3 10am12pm Sat 21 Sept - Sat 5 Oct

Peter Gaggin Mens Masters Coordinator Ph 0419878779

pgaggin@philplighton.com.au

State Masters M Nomination Form & Information Sheet 2013