FWWRB Membership Registration Form

FWWRB Membership APPLICATION

Complete the form below to apply for membership .
Name*

First NameLast Name
FFA Number*
Qualifications*
are you a referee instructor / assessor

YesNo
If Yes What level

Level 3 AssessorLevel 2 AssessorLevel 3 InstructorLevel 2 InstructorOther
Mobile Number*
E-mail*
Address:*

Street Address

Street Address Line 2

CityState

Post code
Birth Date:*

DayMonthYear
Are you currently a member of another referee Organisation*

YesNo
If YES
Name of the organisation
Membership fee Payment

Take out of referee paymentpaid onlineBank TransferCash
Working With Children Check

For members 18 Years or Older
In accordance with the new FNSW Working with Children Policy ALL Referees aged 18 Years or older MUST have a valid PAID working with children Check (WCC ##E)
WWC Category*

I am under 18, this does NOT apply to meI Have a PAID WWC or application Number (please enter it below)
WWC or Application Number
MUST include WWC.....E
Emergency Contact Details
Emergency Contact

First NameLast Name
Mobile Number
E-mail
Address:

Street Address

Street Address Line 2

CityState

Post code
General Availability

Our new referee management system DRIBL is an opt in system. This means that referees will need to indicate that they are available each week (preferably 2 weeks in advance) in order to be appointed to matches. The FWWRB will NOT be doing this for you, it is each individual referee's responsibility to make sure that this has been completed.
Team / Club affiliation

PlayerCoach / Team officialParentOther
Which Team
Name of Club / team.
General Availability

Mid WeekSaturday AMSaturday PMSunday AMSunday PM
Comments relating to your Availability
Bank Details

for match payments (this information is to confirm details on file are current & correct)
Account Name*
Account Details*

BSBACCOUNT Number
Bank Details*
Bank
FWWRB Code of Conduct

All members MUST read , understand and abide by the FWWRB Code of conduct
I have read, understood, and agree to abide by the FWWRB CODE OF CONDUCT.
Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!
Should be Empty:

FWWRB Membership APPLICATION

Working With Children Check

Emergency Contact Details

General Availability

Bank Details

FWWRB Code of Conduct