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Five A Side team nomination form - Winter 2021
To be completed for every competition season. Comp starts from 10th May 2021.
Team Status
*
Returning Team
New Team
Team Name (subject to availability)
*
Managers Details (This will be the main contact for correspondence for this team)
*
First
Last
Email
*
Phone
*
Preferred Playing Night & Division
*
Please select
Monday - Mixed
Tuesday - Men's Social
Wednesday - Women's
Thursday - Men's Social
All players must be CURRENT 2021 registered 5 a side players to participate in any 5 a side season competition. TEAM PLAYER DETAILS:
First Name and Surname
Phone number
FFA number
Club played for in Winter 2021
Player 1
Player 2
Player 3
Player 4
Player 5
Player 6
Player 7
Player 8
Player 9
Player 10
5 A Side Player registration is $120 per player and must be PAID IN FULL AS A TEAM, prior to competition start. There will be no other match fees charged per game.
*
Direct Bank Transfer : IMB BSB:641-800 ACCOUNT NO : 200744102 REF : TEAM NAME
Credit card via phone 0242856929.
In Person at the FSC Office
Payment must be made in full prior to COB Friday 7 May in order to secure your team's position in the competition.
As a representative/agent of the nominated team above, I apply for registration of the team to participate in the 2021 Futsal Competition operated by Football South Coast. If accepted, the team will bound by the rules of the competition and code of conduct as published. All players must have or obtain a FFA number before start of the competition. I/we accept that players who do not satisfy this condition will not be covered by insurance. I/we accept that registration will not be accepted until fees are paid in full and completed registration is received. Registration Fees are NON REFUNDABLE.
I acknowledge and accept the registration rules and conditions.
