Player Registration Fee Refund Request Form following De-Registration

Please read the Refund of Governing Body Fees Policy before completing this form.

This form is for a Club, on behalf of an Amateur Player not wishing to continue playing football during a Season, to apply to Football Queensland for a determination on the eligibility of a refund of Governing Body Fees.

Whilst Clubs are free to make refunds associated with services or products they provide to Amateur Players not wishing to continue playing football during a Season, Clubs or any party are not permitted to refund any fees (registration or otherwise) associated with Governing Body to Amateur Players without first following the Procedure for Recovery of a Refund and before receiving a determination of eligibility for a refund of Governing Body Fees.

Payment of a refund of Governing Body Fees by a Club to an Amateur Player before completing this process is no guarantee of an approved refund back to the Club or any party of the Governing Body Fees when refunded to the Amateur Player.

Player Name*

First NameLast Name

Player FFA Number*

Player Date of Birth*

DayMonthYear

Club Name*

Zone*

Name of Club Official Submitting Request*

First NameLast Name

Position of Submitting Club Official*

E-mail of Submitting Club Official*

Submitting Club Offical Contact Number*

Have you read the Refund of Governing Body Fees Policy to ensure your player is entitled to a refund?*

YesNo

Has the player participated in any form of training session (pre-season or in-season)?*

YesNo

Has the player participated in any form of team trials (formal or informal)?*

YesNo

Has the player participated in any form of player grading or selection processes?*

YesNo

Has the player participated in any pre-season matches, practice matches, official fixtures, or otherwise appeared on a match record for his or her club?*

YesNo

Is the De-Registration complete? i.e it has been approved by club/player and Zone*

YesNo

Please provide the reason under the Refund of Governing Body Fees Policy that entitles your club to a refund (tick all that apply):*

The Registration Status of the Amateur Player has been made “Active” in the National Online Registration System in accordance with the National Registration RegulationsThe Amateur Player has not participated in any form of training session (pre-season or in-season), team trials (formal or informal), player grading or selection processes, pre-season matches, practice matches, official fixtures, or otherwise appeared on a match record for his or her clubThe Amateur Player or their Club has applied for de-registration via the National Online Registration System in accordance with the National Registration Regulations and Registration/De-Registration Periods notified by Football Queensland

Please provide the reason for the De-Registration Request*

DE-REGISTRATION REQUESTS WILL ONLY BE ACCEPTED IN THE FOLLOWING CIRCUMSTANCES:
- PLAYER IS DESIGNATED AS AN AMATEUR;
- PLAYER HAS BEEN MADE "ACTIVE" IN PLAYFOOTBALL;

REFUND REQUESTS WILL ONLY BE ACCEPTED IN THE FOLLOWING CIRCUMSTANCES:
- PLAYER HAS NOT PARTICIPATED IN ANY FORM OF TRAINING SESSION (PRE-SEASON OR IN-SEASON), TEAM TRIALS (FORMAL OR INFORMAL), PLAYER GRADING OR SELECTION PROCESSES, PRE-SEASON MATCHES, PRACTICE MATCHES, OFFICIAL FIXTURES, OR OTHERWISE APPEARED ON A MATCH RECORD FOR HIS OR HER CLUB

PLEASE ALLOW 7 BUSINESS DAYS FOR A DE-REGISTRATION TO BE PROCESSED

IF YOU DO QUALIFY FOR A REFUND AND ANY INFORMATION SUBMITTED IS FOUND TO BE INCORRECT YOUR REFUND MAY BE DECLINED

I, on behalf of the club, agree that all of the above information is true and correct*

I Agree

Administration Fee

AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Player Refund Request Form