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FAMILY LEVY REDEMPTION FORM
Please ensure all information is accurately completed for submission to the committee for approval.
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1
Your Name
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First Name
Last Name
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2
Your Email
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example@example.com
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3
Best Contact Phone Number
*
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Please enter a valid phone number.
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4
Please select the Roles you did throughout the year to be eligible for the refund of your family levy?
*
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WORKING BEE
MUSTER DAY
CLUB HOME GAMES - SET UP/PACK DOWN
CANTEEN & MERCHANDISE
COACHED OR MANAGED A TEAM
WAS A COMMITTEE MEMBER
ASSISTED WITH MOWING THE GROUNDS
OTHER?
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5
PLEASE PROVIDE AN EXPLANATION OF THE DUTIES PERFORMED?
*
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PLEASE BE A DESCRIPTIVE AS YOU CAN INCLUDING DATES/TIMES WORK PERFORMED. I.E. I WAS THE COACH FOR THE U10 ___ TEAM THIS YEAR or I WORKED IN THE CANTEEN FOR 1 HOUR ON THE 10TH MARCH.
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6
PLEASE UPLOAD A PHOTO OF THE TIME-SHEET IF AVAILABLE
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7
IF APPROVED WE WILL ONLY PROCESS YOUR REFUND VIA ELECTRONIC PAYMENT.
*
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YES - Go to Next section for input of details.
NO - Please contact me via phone for this.
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8
Account Name
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9
BANK BSB NUMBER
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10
ACCOUNT DETAILS
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