Coffs Harbour Futsal Club Player Registrations 2022/23

Player name*

First NameLast Name

Parent/Guardian (if player under 18 Years)

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Player Date of Birth*

Date

School Attending (if under 18)

Are you a member of a team already (choose one below)*

YesNo Please place me in team

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Team name / Coach name*

Would you like information about becoming a Referee?

Yes - Please contact meNo

COMPETITIONS*

JUNIORSSENIORS

Seniors*

Coffs Harbour Social Mens Competition Monday Starts 10th October - Fees collected on night at venue $70 match fee per game per teamCoffs Harbour Monday Night Mixed - Fees collected on night at venue $70 per team per game.Coffs Harbour Senior Men - Fees collected on night $70 per team per game. Start Wed 13th OctCoffs Harbour Youth men - Fees collected on night $70 per team per game Start Wed 13th Oct.Coffs Harbour Women - Fees collected on night $70 per team per game. Start Wed 13th Oct.

Do you wish to use a Active Kids Voucher. Select JUNIORS button above

1 Please upload voucher in the upload area immediately below

2 The voucher will be redeemed and you will be emailed a coupon code to use when sign on - This may take 24 hours -

if you do not receive please call Renee on 0448 157 049

3 You will need to open the regsitration form again and enter coupon when you have selected a age group. The price will be ajusted automatically.

Do you wish to pay by Direct Deposit?

Please add Coffs and player name in reference eg CoffsAidanBrown

Australian Futsal Association

BSB 633000

Acc 146 270 582

Please email confirmation and player details to renee@australianfutsal.com

We will then send you the coupon to use to

If using an Active Kids Voucher - Please upload here before progressing.

When voucher is processed you will be sent a code by email that will adjust cost of competition. (allow 24hrs)

When using voucher please add ActiveKids in Coupon box.

My Products*

Coffs Harbour Term 4 - 3-5 Years Little Feet Development Program8 Week Program Starts 26th October to 13 December. 3.30pm to 4.15pm

$90.00AUD

Coffs Harbour Term 4 - 6-12 Years Futsal School Development Program 210 Week Program Starts 12th October to 13 December.

$130.00AUD

Coffs Harbour Under 8s16 Week Roster starting Term 4 -11 October 22 to 13th December Christmas Break return on 7th Feb to to 21st March

$195.00AUD

Coffs Harbour Under 10sTuesdays From 4.30pm - 16 Week Roster starting Term 4 -11 October 22 to 13th December Christmas Break return on 7th Feb to to 21st March.

$195.00AUD

Coffs Harbour Under 12s16 Week Roster starting Term 4 -11 October 22 to 13th December Christmas Break return on 7th Feb to to 21st March

$195.00AUD

Coffs Harbour Under 14s16 Week Roster starting Term 4 -11 October 22 to 13th December Christmas Break return on 7th Feb to to 21st March $195

$195.00AUD

Enter coupon

Total

$0.00AUD

Pay with Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

Coffs Harbour Futsal Club - Player Registrations 2022/23