GDSFA 2024 COTTAM CUP NOMINATION FORM

GDSFA 2024 COTTAM CUP NOMINATION FORM
Club Name*
Team*
Premier League / All Age / Under 21
Member Association*
Member Association Contact*
Referees Association*
Referees Association Contact*
Team Contact Name*
Team Contact Phone*

Area CodePhone Number
Team Contact E-mail*
Home Venue Name*
Please note all fields must have min of 100 Lux for night matches
Venue Address*
Entry Fee (inc GST) $500 must be paid at time of nomination to

GDSFA BSB 062 252 ACC 10089530

Please reference payment with Cottam Cup and Club name

A copy of the remittance must be emailed to

office@granvillesoccer.com.au
What weekday do you prefer to play? Competition scheduled to begin the week of 16th April
Tuesday / Wednesday / Thursday
Date Submitted

MonthDayYear
Date
Should be Empty: