The FA Futsal Fives

TEAM REGISTRATION FORM

Please fully complete both sides of this form and return to your League Co-ordinator with the appropriate remittance by: (19th January 2015

TEAM CO-ORDINATOR CONTACT DETAILS:

First Name / Surname
Address
Post Code / Land Line Telephone No
Mobile Telephone Number / E-mail Address

SQUAD LIST:

First Name
(Block Capitals) / Surname
(Block Capitals) / Email Address

KIT:

Club Colours
Shirt:
Shorts:
Socks:

THE FA FUTSAL FIVES CODE OF CONDUCT – ACCEPTABLE BEHAVIOUR BOND

(Insert Team Name) will:

·  Respect the referee and his / her decisions. All Referees are impartial. Just like the players they may make a mistake. This is part of the game.

·  Follow the instructions of the FA Futsal Fives League Co-ordinator and familiarise yourself with the FA Futsal Fives League Rules.

·  Promote Fair Play - respect your opponent. Win and lose with dignity.

·  Avoid over physical and aggressive play and bad language.

·  Avoid all forms of gamesmanship including time wasting.

·  Show due respect towards match officials.

Failure to adhere the above may result in your team’s exclusion from the FA Futsal Fives League. Any team excluded from the competition will not be permitted to re-register for the league competition.

DECLARATION OF TEAM

I accept full responsibility on behalf of my team to fulfil and pay for all fixtures as required and I agree to abide by the rules of the competition. I am aged 18 or over.

Signature of Team Co-ordinator / Date

TEAM PAYMENT DETAILS

Please enclose the deposit of £ 28

(Cheques made payable to ……Berks & Bucks Football Association…)

Payment Method: The sum of £______is enclosed, to be paid by the following method (complete as appropriate)

  • Credit/Debit card details as follows:

Card Holders Name and Initials as they appear on the card: ______

Cardholder Signature: ______

3 Digit Security Code ______

Valid from Date: ______Expiry Date: ______

Card Issue Number: ______

Please note that the deposit off (£ 28 ) may be retained by the League in the event of non-compliance of The FA Futsal Fives League Rules.

Please complete form and return to the address below:

( or

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