Notes:
1. Please submit this form within 14 working days after the dispatch of the notice referred to in section 8.3(c).
2. Please lodge a fee of $100 together with this Form. Payment can be made by cheque or direct debit into Nepean FA’s bank account. Bank: NAB, Account Name: Nepean Football Association Incorporated, BSB: 082778, Account Number: 743851885. Please file receipt of payment into this account with the Tribunal Administrator at tribunals@nepeanfootball.com.au.
3. Members should read and consider sections 8, 11 and 12 of the Regulations prior to signing and lodging this Form ton Nepean FA.
4. Pursuant to section 8.3 of the Regulations, your Claim or Complaint will be dealt with by mediation (section 11 of the Regulations) in the first instance unless Nepean FA believes that the claim or complaint should be referred to a GPT.
5. If Nepean FA does not receive a properly completed Form by the time specified in paragraph 1 together with the $100 fee, you waive your right to have the matter heard at Nepean FA.
6. Capitalised words used in this document are defined in the Regulations.