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Please return completed forms to AIMMNA PO Box 607 Elizabeth SA 5112 or email to pturk samna.org. au AGE DECLARATION Please note All Players and Officials need to be registered with AAIMMNA Inc. When lodgement of the Age Declaration form please provide a copy of either Proof of Age ID Drivers Licence Birth Certificate. PERSONAL DETAILS Name Postal Address Mobile State Email Date of Birth / / DIVISION S Please tick appropriate division s Open 19 and under Open Reserves Mixed 23 and under We hereby declare that the above registered player detailed on the official AIMMNA Player/Official Registration form are in fact of the correct age for the stated Age Division. We undertake the onus of integrity when we as a National Body/Team/Club/Association do declare that this player is eligible for such Division* We will provide documentation for the said player in the form of a copy of either Proof of Age ID Driver Licence P/C Name of Office Bearer Position Held Address Phone w Fax h Signature of Office Bearer Date / / Name of Witness Signature of Witness Office Use Only Age Verified Registration No Proof Attached. PERSONAL DETAILS Name Postal Address Mobile State Email Date of Birth / / DIVISION S Please tick appropriate division s Open 19 and under Open Reserves Mixed 23 and under We hereby declare that the above registered player detailed on the official AIMMNA Player/Official Registration form are in fact of the correct age for the stated Age Division. We undertake the onus of integrity when we as a National Body/Team/Club/Association do declare that this player is eligible for such Division* We will provide documentation for the said player in the form of a copy of either Proof of Age ID Driver Licence P/C Name of Office Bearer Position Held Address Phone w Fax h Signature of Office Bearer Date / / Name of Witness Signature of Witness Office Use Only Age Verified Registration No Proof Attached.

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