1. Please submit this form within 14 working days after the dispatch of the notice referred to in section 9.3(c).
2. Please lodge a fee of $500 together with this Form. Payment can be made by cheque or direct debit into Football NSW’s bank account. Bank: National Aust Bank Ltd, Account Name: Football NSW Limited, BSB: 082-356, Account Number: 14-055-1058. Please file receipt of payment into this account with the Tribunal Administrator at firstname.lastname@example.org.
3. Members should read and consider sections 9, 12 and 13 of the Regulations prior to signing and lodging this Form toFootball NSW.
4. Pursuant to section 9.3 of the Regulations, your Claim or Complaint will be dealt with by mediation (section 12 of the Regulations) in the first instance unless Football NSW believes that the claim or complaint should be referred to a GPT.
5. If Football NSW does not receive a properly completed Form by the time specified in paragraph 1 together with the $500 fee, you waive your right to have the matter heard at Football NSW.
6. Capitalised words used in this document are defined in the Regulations.