2016 Universities Rugby League Queensland Team Application

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* 1. First name:

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* 2. Last name:

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* 3. Email:

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* 4. Mobile number:

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* 5. Date of birth:

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* 6. University/TAFE:

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* 7. Student number:

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* 8. Current tertiary course (eg. Bachelor of Business):

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* 9. Anticipated year of graduation:

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* 10. Primary playing position:

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* 11. Secondary playing position:

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* 12. Heights (cms):

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* 13. Weight (kgs):

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* 14. Current rugby league club and team:

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* 15. Highest level of competition played:

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* 16. Coach and coach's contact details for playing reference:

Coach's Name:

Coach's contact number: