First Name

Middle Name

Last Name

Full Postal Address

Mobile Phone Number

(please select all that apply)

a parent or guardian of a registered Junior Playing Member;

a coach or manager of a team competing in any competition conducted by the Association;

a coach or manager of any representative team of the Association;

a referee acting as such in any competition conducted by the Association;

any scorebench official;

a registered volunteer;

any other person.

If you selected “any other person”, please add any additional commentary that is relevant to your application

Please add any additional commentary that is relevant to your application

Honorary Membership Application

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