Application to join the Middlesex County Football League
Season 2013 - 2014
Please type or hand-write in CAPITALS
Name of ClubYear Club was founded
Status (senior/intermediate/junior)
County FA affiliated to
Home Ground
Name & Address
Dates when home ground is available From To
Is Home Ground privately or council owned?
How many teams applying?
Previous League 1 years played From To
Previous League 2 years played From To
Previous League 3 years played From To
Name of Club’s Bank
Confirm that you have a registered First Aider (yes/no) Name:
Club Chairman / Name
Address
Telephone Numbers
Club Secretary / Name
Address
Telephone Numbers
Signed ______(Secretary) Date______
Signed ______(Chairman) Date______
When completed, please return this form together with an entrance fee of £50.00 and your deposit of £20.00 per team this form will not be processed unless the cheque is attached
Please date cheques 1st June 2013payable to Middlesex County Football League
Send to:
Middlesex County Football League
27 St Georges Road
Hanworth
Middlesex
TW13 6RD
Both the entrance fee and deposit will be returned in the event of non-election.
Application Form 2013 - 2014
All sections marked * MUST be completed
Name of Club / * / 1st/Res / *County of Affiliation / * / Affiliation No / *
Club Colours / Shirts / * / Alternative / Shirts / *
Shorts / * / Shorts / *
Socks / * / Socks / *
Please supply as many phone numbers as possible. It is COMPULSORY to supply an emergency contact. It is NOT compulsory to supply your business number.
Club website / www.
Secretary’s Name / * / Tel (Home) / *
Address / * / Tel (Work)
Fax / *
Mobile / *
e-mail address / *
Fixtures Sec. Name / * / Tel (Home) / *
Address / * / Tel (Work)
Fax / *
Mobile / *
e-mail address
Emergency contact name / * / Tel / *
Programme Editor / Tel
Address / Tel
Fax
Mobile
E-mail address
Ground name and address & postcode / * / Tel No:
Other info
Directions to ground / *
Club Secretary’s Signature / * / Date / *
Please complete and return this form to arrive no later than 1st June 2013. Send to:
Stephen C Hosmer,
MCFL Secretary
27 St George’s Road, Hanworth, Middx TW13 6RD
APPLICATION FORMS WILL NOT BE ACCEPTED UNLESS ACCOMPANIED BY A POST DATED CHEQUE FOR £70-00.,
Ground Information
Season 2013 – 2014
You must submit a separate form for each team where the ground details are different.
Team Name:
State whether First Team, Reserves, “A” etc
Affiliated to: Middlesex County / London / Berks & Bucks / ______Football Association
Ground name
and address
______
______
Please tick
Yes No Floodlights
Yes No Dugouts
Yes No Permanent Post & Rail
Yes No Ground has permanent barrier and turnstiles
Yes No Exclusive use of ground. If no, shared with ______of ______League
Yes No Separate lockable changing rooms for home and away teams
Yes No Separate showers for home and away teams
Yes No Communal showers
Yes No Separate lockable changing room for match officials Yes No en suite shower
Yes No Clubhouse
Yes No Licensed bar
Yes No Car Park. If yes, for approx. _____cars.
Ground privately owned Ground leased Ground rented from local Council
Pitch hired from Council Name of local Council______
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