Notes:
1. Please submit this form within 14 working days after the dispatch of the notice referred to in section 9.3(c).
2. Please lodge a fee of $500 together with this Form. Payment can be made by cheque or direct debit into BDSFA's bank account. Bank: Commonwealth Bank Ltd, Account Name: Blacktown & Districts Soccer Football Association, BSB: 062 121, Account Number: 00909770. Please file receipt of payment into this account with the Tribunal Administrator at admin@bdsfa.com
3. Members should read and consider sections 8, 11 and 12 of the Regulations prior to signing and lodging this Form to the BDSFA.
4. Pursuant to section 9.3 of the Regulations, your Claim or Complaint will be dealt with by mediation (section 12 of the Regulations) in the first instance unless BDSFA believes that the claim or complaint should be referred to a GPT.
5. If BDSFA does not receive a properly completed Form by the time specified in paragraph 1 together with the $500 fee, you waive your right to have the matter heard at BDSFA.
6. Capitalised words used in this document are defined in the Regulations.