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Membership type (player, official, life member, supporter)
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Personal information such as First Name, Middle Initial, Surname, Maiden or Other Names, Date of Birth, Address, Email, Phone Number, Mobile Number.
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Club registering with (Dimboola, Horsham, Kaniva, Nhill, Warracknabeal, Yanac)
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Permission if Under 18
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Acknowledge that you have read and agree to abide by the WHA By-Laws
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Acknowledge that you have read and agree to abide by the Hockey Victoria Codes of Behaviour
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Images permission. WHA requests that all members tick for permission for WHA to use photos/images of yourself. Anyone not allowing for photos to be published must be aware that they will not be able to be in ANY photos, which includes any team photos, presentations photos, etc. This also refers to any video footage which may be taken.
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Note that completing this on-line registration form is equivalent to signing a hard copy registration.
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Registration declaration: that by registering with the WHA you agree to abide by the rules, acknowledge that information given is correct to your knowledge