Qld Over 50’s Nomination Form

National Championships 2022 – Adelaide

(Saturday evening) 19th Nov to (Thurs wind-up Dinner) 24th Nov 2022

Please complete this form if you would like to be considered for Selection for the National Championships in Adelaide this year.

Queensland will be taking 7 teams and will compete in all 5 Divisions.

The State Squad will be announced on August 29 2022.

Unfortunately we expect more nominations than available spots again, so not everyone will be able to attend as a player.

We do have roles for Managers and Scorers.

"*" indicates required fields

1. Name, DOB and Contact details

Surname*

Given Name*

DOB*

DD slash MM slash YYYY

Must be 50 or older in 2022

Contact Phone*

Your Email address*

Your Local Association*

Any medical issues we need to be aware of

Emergency Contact Person*

Emergency Contact Phone Number*

2. What role are you Nominating for? Select yes in the selection. You can have multiple roles.

Player

Yes

Manager

Yes

Scorer

Yes

Umpire

Yes

Supporter/Partner

Yes

3. Please indicate where you normally Bat with a Yes.

Top-order

Middle-order

Lower-order

4. If you bowl, please describe?

Bow description

5. I agree to make a $250 deposit before the 12th of August and make the full payment balance by the 21st of October. Bank account details are BSB 484-799 account number 350515299. Reference is Queensland Over 50s Cricket and From is your name.

Finalised costs will be advised when confirmed. Likely to be approximately $1200. If you are not selected this amount will be refunded. Some people have funds already with QVC from previous cancelled carnivals so will not need to make this deposit.

Phone

This field is for validation purposes and should be left unchanged.

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