01223430120 56789763 6 73 - Queensland Cricket

DUAL REGISTRATION FORMa. The applicant is responsible for making the initial application to the relevant Primary Association.b. Once approved, the applicant is then responsible for making application to the relevant Secondary Association.c. Upon receipt of such advice, Queensland Cricket will make a determination and advise the relevant parties (hard copyapprovals by request).d. Dual registration is valid only for the cricket season in which the application is approved.e. The Secondary Association retains the right to levy or not levy a fee for the approved applicantf. The official signing must indicate position held in Association / Club.NOTIFICATION OF DUAL REGISTRATIONApplicant: (Please use BLOCK letters)SurnameSignatureFirst Name:Date:Primary Association:Position Held:Primary Club Name:Position Held:Officials Name:Signature:Officials Name:Signature:Secondary Association:Position Held:Secondary Club Name:Position Held:Officials Name:Signature:Officials Name:Signature:The applicant aforementioned wishes to formally apply for dual registration with the above Associations.The applicant agrees that the Primary Association has the right of first refusal for selection in any Representative Teams, and subject to anyagreement to the contrary (such agreement must be annexed hereto), agrees that his/her first priority will be with the Primary Association.Office Use OnlyApproved / /2 QC (Signature) Advised PrimaryNot Approved / /2 Advised Secondary120