Application Form & Agreement - Local Futsal Centre 2018-2019

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1. Application Process
The Application Process to seek Football NSW endorsement of Community Futsal Competition comprises;
Competition Information; and Terms and Conditions Both of these processes are combined in this document.
Prospective Community/Local Futsal Competition Administrators are required to submit this document having answered all questions and executed where required.
Upon approval, Football NSW will confirm the agreement with a confirmation letter and return to the Competition Administrator.
2. Submission
Each Applicant is required to complete this application process:
This form must be completed by an authorised person of the Applicant.
By submitting the form, the Applicant will be deemed to have reviewed, acknowledged and agreed to the terms and conditions set out in the form without reservation or variation.
Should you require any assistance in completing this form please contact the following Football NSW employee:
Demelza Howard
Email: [email protected] Telephone: (02) 8814 4465
Name of Applicant (i.e legal entity name)*
ABN of Applicant*
Designation of Applicant*
Note: All Applicants must be a registered entity i.e. a body corporate registered under the Corporations Act 2001 or an incorporated association registered under the Associations Incorporation Act 2009 (NSW).
Host Applicant Logo*
Applicant Postal Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Host Applicant Website*

Please ensure you include the following format when entering 'http://www....
Host Applicant Facebook
Contact Person of Applicant*
First Last
Contact Person Phone Number (mobile)*
Contact Person Phone Number (office)
Contact Person Email Address*
Alternative Contact Person Email Address

Competitions
Please indicate the Gender and Age Grades you propose to conduct
Age Grade / Format /Division / Day*
For example - Please indicate the Format(s) you propose to conduct for example, Mixed Seniors, 2 Divisions, Tuesday Nights.
Venue Name*
Venue Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number of Courts at Host Centre*
Number of Dressing Rooms at Host Centre*
Do You Have Access to a Canteen*
Do you have access to a medical facilities (i.e. medical kit, medical room etc.)?*
Indicate the competition dates for your competition year*
i.e. commencement and conclusion dates for each competition.
What day(s) of the week does your competition run?*
Do you have your own Competition Regulations?*
Yes
No
If yes can you provide a copy of the regulations

Additional Resources and Competitions
Would you like to be contacted about the Futsal Cup or Community Futsal Competitions run by Football NSW for your local teams to enter*
Please indicate if you would like any of the following resources:*
Are you interested in Local Futsal Champions of Champions? ( knockout competition)?*
Acknowledgement
I,*
First Last
Insert your name
In my capacity as*
Insert title)
READ HERE
I have read and agreed to the above terms and conditions:*
Yes - I have read and agreed to the above terms and conditions:
I also acknowledge and agree to the following: I am a person who is authorised to sign this form on behalf of the Administrator; the Administrator agrees to comply with the requirements and obligations set out in this form; on behalf of the Administrator, I have read and understood the form in relation to the Futsal Local Centre structure; and on behalf of the Administrator, I have completed this form to the best of my knowledge and ability and the contents of my submission are true and correct.
Digital Signiture*
First Last

Application Form & Agreement – Local Futsal Centre 2018-2019

Application Form & Agreement - Local Futsal Centre 2018-2019

Step 1 of 3

Competitions

Additional Resources and Competitions

Acknowledgement

Head Office

Postal Address

Office Hours

FOOTBALL NSW ASSOCIATIONS