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NOMINATION FORM

Tasmanian Mens Masters Team 2014


Australian Masters Championships Cairns Queensland 26
September 10 October 2015
Players wishing to be considered for selection in a 2015 Tasmanian Mens Masters Team must
complete the attached nomination form and return by Friday 1 May 2015, 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

Date of Birth

Postal Address

State

Phone (h)

Phone (m)

Email Address

Post
Code

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

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)

HockeyEd / NCAS Coaching


Accreditation (please circle current level
of accreditation)

I wish to nominate as a Tasmanian Selector


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)

Beddin
g

Date of
Expiry
O35 / O40 / O45 / O50 /
O55/ O60 / O65

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

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

No

O35 / O40 / O45 / O50 /


O55/ O60 / O65
O35 / O40 / O45 / O50 /
O55/ O60 / O65

I would like HT to organise my


accommodation

(please indicate no of people and bedding


configuration required eg Q or singles)
Names of others with whom you wish to
share an apt

Year of
Accreditati
on

O35 / O40 / O45 / O50 /


O55/ O60 / O65
O35 / O40 / O45 / O50 /
O55/ O60 / O65

I require
accommodation on
the following dates

Date
IN

Date
OUT

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 15; 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

Please debit $200 to my credit card


Mastercard

Credit card #
Card holders
name
State Masters Men - Nomination Form & Information Sheet 2015

Expiry date
OFFICE USE
ONLY

Signature
Date of payment

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 2015
Australian Masters Championships Cairns Queensland 26 September 10
October 2013
The Australian Masters National Championships are scheduled to be held in Cairns Queensland
commencing Saturday 26 September 2015 and concluding Saturday 10 October. From the Draft
Roster it is understood the 035, 040 and 045 will be of 9 days duration (weekend to weekend)
and held in the first week of the tournament.
The other Divisions / Grades will be spread over the fortnight.
Information about the Championships can be found at 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 2015. (ie to be eligible for 040 you must have been
born on or before 31 December 1975, 045 / 1970, etc)
The closing date for player nominations is Friday 1 May 2015. The cut-off date for any late
nominations is Friday 22 May 2015 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 2015; 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 Tasmanian
team official. Closing date for nomination for coach or manager positions is Friday 1 May 2015
Please return completed form with payment to: accounts@hockeytas.com.au or post to
Accounts, Hockey Tasmania Finance Officer, PO Box 96 NEW TOWN TAS 7008
In addition to airfare and accommodation, an estimate of team costs is provided below. Players
are responsible for their travel arrangements to and from Cairns and accommodation is being
organised through Hockey Tasmania.
Estimated Cost per Player - Team Expenses
HA Team Entry Fee
HA Masters Levy
Team Vehicle & Fuel
Team Photo
Post-Match Drinks
Post Game Presentation awards etc
Umpires' Travel & Accommodation
Physio Services & Consumables
Manager- General Expenses
Training & Equipment
HT Awards Team Contribution

$47.00
$12.00
$190.00
$20.00
$45.00
$14.00
$65.00
$65.00
$5.00
$15.00
$6.00

State Masters Men - Nomination Form & Information Sheet 2015

Total
$484.00
Other indicative estimates of cost (from 2014 costs)
Estimates of cost
Uniform minimum expectation is shirt, shorts
and socks.
Uniform is the same as 2014.
Min $150
Accommodation estimate (10 nights)
$825.00
Airfare (best price self sourced) say:
$800.00
Spending money / food / etc
Personal
Peter Gaggin
Mens Masters Coordinator
Ph 0419878779
pgaggin@philplighton.com.au

State Masters Men - Nomination Form & Information Sheet 2015

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