19's to 23 Squires

Squires 19-25's

Please complete this form if you are interested in representing Malta Heritage Rugby League. .
Men's Comp

* Indicates required field

Players Photo *

Max file size: 20MB

Year of Birth *

Day / Month *

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parents Name *

Mobile Number *

Email *

Current Registered Club *

NRL Number *

Region Eg. Penrith *

Division *

Position *

Players Birth Certificate *

Max file size: 20MB

** Birth Certificates are required to complete the registration interest.

Proof of Maltese Heritage *

Max file size: 20MB

* Best proof is Players parents Birth Certificate. This will show grandparents place of birth.

Submit