Eighties Membership Application

Username *
Username
Email *
This can be changed but your Username remains as the first email address entered.
Password *
A mix of leTTers, n7M+B3rs! and Th!mbl#s
Membership Level *
Eighties
Player ID
Leave blank - we shall add this (format XX99). Use this prefixed with TOPUP (as in "TOPUPXX99") as the bank reference in payments you make to us.
Shirt Number
Leave blank. This will be added once allocated

First Name known as *
Name you want us to use socially and in emails (e.g. Mike).
Formal First Name *
The same as Known As or your official first name (e.g. Michael)
Last Name *
Last Name
Address *
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Mobile Phone *
If no mobile use home phone number.
Contact me *
Yes
No
We need YES to contact you about playing events and Thistles participation (you will not be inundated). NO will limit contact to formal matters only (e.g. AGM).

Date of Birth *
Select from the calendar or enter eight digits dd/mm/yyyy.
Playing Section *
Associate your membership with one of these two playing section: Ladies/Female or Men/Male. (Not Specified means receiving double information.)
Main Playing Role *
Goal Keeper
Defence minded
Midfield minded
Attack minded
Umpire
None of Above
Do you primarily consider youself as a: GK, Def/Mid/Att or as an umpire?
Hockey Club *
Name of the "Saturday" hockey club you are associated with. Use NA where not applicable.
Playing District *
Sc-North
Sc-Midlands
Sc-East
Sc-West/SW
England
None of Above
Four SCOTTISH districts to associate yourself with or ENGLAND or None of Above
Emergency Contact *
Name, relationship to you, mobile number and email address of the person(s) to contact in case of emergency.
Other
Other information if required