SOUTHGATE COUNTY FC
CLUB REGISTRATION FORM
SEASON 2014-15
The data below is required by the League & County Football Association
All data supplied will remain confidential under the terms of the Data Protection Act
Player Name : __________________________________________________________
Full Address: ___________________________________________________________
___________________________________________________________
___________________________________________________________
Full Postcode: _______________________
Date of Birth: ________________________
Email Address: ________________________________________________
Mobile Number: ____________________________
Home Number: ____________________________
Work Number: ____________________________
School: ____________________________
Date joined SCFC: ____________________________
Previous Clubs: ____________________________
Medical Conditions: ____________________________
I agree to abide by the rules and code of conduct of Southgate County Football Club and I agree to play for the club for whichever team I am selected.
I am not under any suspension by another club or a county FA or owe monies to such bodies.
I am aware that an annual membership fee of £25 must be paid by the 31st October 2014.
Signed: ____________________________ Date: ________________