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Junior Rugby League Registration Reimbursement Form
*This form must be submitted by the parent/guardian who completed the child’s registration.
Player's details
NRL ID Number
*
* Please insert number only
Player's Full Name
*
First
Last
Club Registered To
*
SELECT ONE
Berkeley Vale JRL Football Club
Blue Haven JRL Football Club
Budgewoi Buff Point JRL Football Club
Erina JRL Football Club
Gosford Kariong JRL Football Club
Kincumber JRL Football Club
Northern Lakes JRL Football Club
Ourimbah / Wyoming JRL Football Club
Terrigal / Wamberal JRL Football Club
Toukley JRL Football Club
Umina JRL Football Club
Woy Woy JRL Football Club
Warnervale JRL Football Club
Wyong JRL Football Club
Age
*
Parent's details
Parent's Full Name
*
First
Last
Contact Number
*
Email Address
*
Bank details for reimbursement
BSB
*
Account Number
*
* Please ensure the account number is correct
Bank Account Name
*
* Please ensure account name matches banking details
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