Westfield FFA Cup 2016 Preliminary Round Registration Form

Westfield FFA Cup 2016 Registration Form
Club Administration
Club Name:*
Club Contact Name:*
Club Contact Email:*
Club Contact Mobile:*
Alternative Club Contact Name:
Alternative Club Contact Mobile:
Are you a PlayStation 4 NPL NSW Men's or Football NSW State League Men's Club?*

YesNo
Affiliated Association:*
Venue Details
Club Venue Name:*
Club Venue Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is Club Venue Address the same as Club Billing Address*

YesNo
Club Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Lights (minimum 100 Lux):*

YesNo
Pitch Perimeter Fence:*

YesNo
Dressing Rooms:*

YesNo
Available 12th/13th March*

YesNo
Available 19th/20th March:*

YesNo
Playing Kit Colours
Home Kit Colours
Field Player Home Shirt:*
Field Player Home Shorts:*
Field Player Home Socks*
Goalkeeper Home Shirt:*
Goalkeeper Home Shorts:*
Goalkeeper Home Socks*
Away/Alternate Kit Colours
Field Player Away/Alternate Shirt:*
Field Player Away/Alternate Shorts:*
Field Player Away/Alternate Socks:*
Goalkeeper Away/Alternate Shirt:*
Goalkeeper Away/Alternate Shorts:*
Goalkeeper Away/Alternate Socks*
I acknowledge and agree that:

a) the information I have provided is accurate;

b) I am authorised to submit this form on behalf of the Club; and

c) by signing this form, the Club shall participate in the Westfield FFA Cup 2016 and shall be bound by the Westfield FFA Cup Competition Regulations as promulgated by FFA from time to time.
I acknowledge and agreee to the Terms and Conditions above.*

YES
Enter the message as it's shown*
Should be Empty:

Westfield FFA Cup 2016 Registration Form

Club Administration

Venue Details

Playing Kit Colours