GRANVILLE DISTRICT FOOTBALL REFEREES ASSOCIATION Inc. Assoc No: Y1061210
PO Box 66 Merrylands 2160. Phone/ Fax: 9896 8539 Mobile: 0400 195 210
2017 APPLICATION for MEMBERSHIP FORM
Family Name: Given Name(s):
Date Of Birth: / / Partner's Name: (Optional)
Address:
Home E-Mail: Work E-Mail:
Home Phone No: Work Phone No:
Mobile: Carrier: Fax:
FFA ID:
No -Yes -
Do you have daily access to the Internet? Please tick box:
Seniors $95 - (19 Years as at 1st January) / Juniors $75 - (18 Years as at 1st January)Cheque or Direct Credit to:
Granville District Football Referees Assn
BSB: 062428 Account: 28000336 / Fee Enclosed/Paid: $
Receipt No:
Your Bank A/C Name: (e.g John C Smith)______Type of A/C: savings / cheque / other
Name of your Bank: Branch Address:
BSB No: / - / A/C No:Junior Member Parent/Guardian Declaration.
Do you have an affiliation with a club(s)? If so provide details: eg Coach; Manager, Player, Child, Committee
______Club(s): ______Age: _____ Div: ____
______Club(s): ______Age: _____ Div: ____
Transport (Please specify, Parents, Public, Own vehicle, etc.) ______
What other Referee Association do you belong to or have you ever belonged to: ______
Membership Declaration
Ø I agree that if this application is accepted that I will be bound by the Constitution and By Laws of GDFRA Inc;
Ø I acknowledge that GDFRA Inc Inc is a volunteer organisation, and as such the onus is on me to fulfil my obligations without relying on reminders from the Committee
Ø I acknowledge that through affiliation with Granville & Districts Soccer Football Association, and Football NSW I am also bound by their respective Constitution and By Laws;
Ø I acknowledge that I will be required to successfully complete a fitness test as determined by the Committee from time to time before I can be appointed to certain matches;
Ø I acknowledge that I will be required to attend a pre-season Technical Education seminar to be eligible to be appointed to certain matches;
Ø I acknowledge that I will be required to meet the physical training requirements as determined by the Committee from time to time; to be eligible to be appointed to certain matches;
Ø I acknowledge that I will be required to meet the Technical Education requirements as determined by the Committee from time to time to be eligible to be appointed to certain matches;
Ø I acknowledge and understand that GDFRA Inc may provide certain personal information to affiliated bodies such as Football NSW and Football Federation Australia as necessary for the purposes of administering their competitions.
SIGNATURE: ______DATE: ______
Management Committee’s Decision: Approve / Reject: - Date of Meeting ______