2019 FFA Cup Club Registration Form

2019 FFA Cup Club Registration Form Football Victoria
Club Details
Club Name*
Club Contact Details
Full Name*

First NameLast Name
Position*
Email*
example@example.com
Contact Number*
Playing Strip Information
Home Top*
Away Top*
Home Shorts*
Away Shorts*
Home Socks*
Away Socks*
Ground Access
Please select the relevant Rounds your clubs venue is available to host FFA Cup Fixtures OR leave blank if you are unable to host:*

Qualifying Round 1: February 9Qualifying Round 2: February 16Round 1: February 23Round 2: March 2Round 3: March 9Round 4: April 14 (midweek) & April 20Round 5: April 5 (midweek) & 12 (midweek)Round 6: May 26 (midweek) & June 2 (midweek)Round 7: June 16 (midweek) & June 23 (midweek)Unable to Host
Club has received venue owner approval to host FFA Cup fixtures e.g. letter of approval from council*

YesNoPrivate VenueWaiting on confirmation
In the situation your club is allocated a home fixture, would your club be available to host other FFA Cup Fixtures subject to council approval?*

YesNo
Terms and Conditions

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 participating in the Preliminary Rounds of the FFA Cup, the Club shall be bound by the FFA Cup Competition Regulations as promulgated by FFA from time to time.
I acknowledge and agree to the above Terms and Conditions above.*

Yes
Should be Empty:

2019 FFA Cup Club Registration Form Football Victoria