Men’s 2015 World Indoor Lacrosse Championships Tryout Registration Form

Personal Details

Your Name (required)

Your Email (required)

Birthdate (required)

Height (required)

Weight (required)

Postal Address(required)

Normal Residence(required)
IrelandOther

Other:

Passport(required)
IrelandOther

Other:

Passport Number:

Medical Information
Lest any health concerns you have

Insurance Company(required)

Company Address(required)

Policy Holder Name

Emergency Contact Name(required)

Relation

Emergency Contact Phone Number (Required)

Lacrosse Details

Lacrosse Experience - Only complete if you have never represented Ireland previously

Position Played (Required)
GoalieAttackTransitionDefense

Hand (Required)
LeftyRighty

Preferred Position (Required)

By ticking the checkbox below, I hereby state that the questions on this form have been answered completely and truthfully to the best of my knowledge.

Participant acceptance: (required)
YesNo

Name

The selection camp will happen in Dublin from Friday, 31st October until Sunday 2nd November.  Further specific details will be provided closer to the time.

The Selection Camp Registration Fee is €80 or $110 (including registration on the first day of the selection camp). Payment may be made online – once the online registration form has been completed and sent the facility for payment will appear.