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Nomination Form

Please fill out your details below:

Please complete all the information below to submit your Futsal Nomination Form to Five Dock Leisure Centre.

Denotes a required area

Team Name:
Competition:
1. Night Div:
2. Night Div:
3. Night Div:
Playing Strip (Colours):
Jersey: Shorts:
Socks:
Team Contact:
Name: Phone:
Address:
          Post Code :
Email:
Players Details:
Player
Names:
Date of Birth:
(dd/mm/yyyy)
Phone Number:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
           

This nomination form must be submitted by Tuesday 1st March, 2007.

Please note that once team positions have been filled then each division will be finalised. Nominations are open til 1st March 2007 however not guaranteed positions on that date.

Fees payable upon nominating: $30.00 team nomination fee & $200.00 team bond
                                                                              
The following conditions apply to the $200.00 bond paid:
*The $200.00 bond paid will only be refunded in full if my team does not forfeit any matches (regardless of notice prior to match)
*$100.00 is deducted from the bond for each forfeit.
*If the team forfeits two (2) matches during the season, they may be removed from the competition unless another $200.00 bond is paid immediately after the second forfeit.
*The bond will be refunded via a cheque to the nominated team contact.

 
 
Five Dock Leisure Centre
Cnr Queens Road & William St,
FIVE DOCK NSW 2046
(02) 9744 2622
(02) 9744 2701
 
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