GOLDEN SOUTH JAGUARS 2009

INTENT TO TRIAL NOMINATION




Name:.................................

		Team:  Tier 1(HAC)  


      
                       Tier 2 (EEC)


Address:  .......................................

		
Postcode: .......................................


Contact:  .......................................

	
(H)
	
(W)
	
(M)

	
Email (pls print): ..............................
	
Date of Birth:     ..............................
		
Preferred Positions	1........  2.........

Association	   ..............................


In order to assist with trials please forward the above completed form by 
Monday 20th January 2009 either by email or post to:

Jennyne Dillon
President
Golden South Region

Contact details above.