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PERSATUAN FLOORBALL NEGERI SELANGOR (No. Ruj. 7052/2014) TEAM REGISTRATION FORM SFA-T01 FORM Ref. no: STA-C01

PERSATUAN FLOORBALL NEGERI SELANGOR (No. Ruj. 7052/2014)

TEAM REGISTRATION FORM

SFA-T01 FORM

Ref. no:

STA-C01

Register Status

Year:

New

On time

Late 1

Late 2

 

TEAM INFORMATION

Team name:

Tournament / Event:

 

Affiliates

     

Team colors:

(school/university/company):

No. of players:

Date establish:

Category:

Level: ( SCHOOLS / VARSITY / OPEN )

 

(MALE / FEMALE / MIX)

Mailing Address:

Manager full name:

Manager mobile phone no.:

 

Team / Manager e-mail address:

Manager NRIC or passport no.:

Nationality:

 

Assistant manager full name:

Assistant manager mobile phone no.:

 

Assistant manager NRIC or passport no.:

Nationality:

Coach full name:

Coach mobile phone no.:

 

Coach e-mail address:

 

Coach NRIC or passport no.:

Nationality:

 

TEAM DECLARATION

I, (manager full name)

, (NRIC or Passport no)

As the manager of the team as stated above, declare on behalf of the club that:

 

All information provided in form SFA-T01 & SFA-T01A is true and complete to the best of my knowledge and belief.

I undertake that, by registering the team to the event organized by Selangor Floorball Association (“SFA”), the team and all the registered players attached to the team shall abide the rules made according to the rules and regulations of the tournament.

I undertake that, SFA, the committee members and relevant associate party of SFA will not be hold responsible for any unforeseen incidents or mishaps that may occur to all registered players of the team while participating in any events of SFA or SFA endorsed events.

(Manager signature) :

(Date) (DD/MM/YY) :

(Payment amount) :

 

For SFA use only

 

TEAM FEE

RM

TEAM PENALTY

RM

GRAND TOTAL

RM

RECEIPT NO

 

DATE

 

SIGNATURE

 

[PRESIDENT]

SIGNATURE

 

[HON. SECRETARY]

Within transfer window

N.A

Transfer window

N.A

New club

N.A

Returning club

N.A

Recurring club

N.A

Last Register Year

N.A

Total player forms submitted

N.A

Total player registered

pax

Total late registered player

N.A

Register Status Checklist

Early registration 0

RM 250

New registration 00

N.A

Late registration 1

N.A

Late registration 2

N.A

Approve / Reject

Date:

Reason of rejection :