Club Information Sheet
Club Name
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Secretary
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (Mobile)
*
-
Area Code
Phone Number
Phone Number (Home)
-
Area Code
Phone Number
Phone Number (Work)
-
Area Code
Phone Number
Email
*
example@example.com
President
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (Mobile)
*
-
Area Code
Phone Number
Phone Number (Home)
-
Area Code
Phone Number
Phone Number (Work)
-
Area Code
Phone Number
Email
*
example@example.com
Registrar
Name
*
First Name
Last Name
Phone Number (Mobile)
*
-
Area Code
Phone Number
Phone Number (Home)
-
Area Code
Phone Number
Phone Number (Work)
-
Area Code
Phone Number
Email
*
example@example.com
Club Fixture Officer
Name
*
First Name
Last Name
Phone Number (Mobile)
*
-
Area Code
Phone Number
Phone Number (Home)
-
Area Code
Phone Number
Phone Number (Work)
-
Area Code
Phone Number
Email
*
example@example.com
Wet Weather Contact (Primary)
Name
*
First Name
Last Name
Phone Number (Mobile)
*
-
Area Code
Phone Number
Phone Number (Home)
-
Area Code
Phone Number
Phone Number (Work)
-
Area Code
Phone Number
Email
*
example@example.com
Wet Weather Contact (Secondary)
Name
*
First Name
Last Name
Phone Number (Mobile)
-
Area Code
Phone Number
Phone Number (Home)
-
Area Code
Phone Number
Phone Number (Work)
-
Area Code
Phone Number
Email
example@example.com
MPIO (Member Protection Information Officer)
Name
*
First Name
Last Name
Phone Number (Mobile)
*
-
Area Code
Phone Number
Phone Number (Work)
-
Area Code
Phone Number
Email
*
example@example.com
Working With Children Check Officer
Please give details of the Committee Member in charge of collecting WWCC numbers
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Club Coaching Coordinator
Name
First Name
Last Name
Phone Number (Mobile)
-
Area Code
Phone Number
Phone Number (Home)
-
Area Code
Phone Number
Phone Number (Work)
-
Area Code
Phone Number
Email
example@example.com
Club Small Sided Football Coordinator
Name
First Name
Last Name
Phone Number (Mobile)
-
Area Code
Phone Number
Phone Number (Home)
-
Area Code
Phone Number
Phone Number (Work)
-
Area Code
Phone Number
Email
example@example.com
Primary Delegate to the Association
Name
*
First Name
Last Name
Phone Number (Mobile)
*
-
Area Code
Phone Number
Phone Number (Home)
-
Area Code
Phone Number
Secondary Delegate to the Association
Name
*
First Name
Last Name
Phone Number (Mobile)
*
-
Area Code
Phone Number
Phone Number (Home)
-
Area Code
Phone Number
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Nominated Home Ground
Full Name of Ground
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number at Ground (If Applicable)
-
Area Code
Phone Number
Registered Colours and Emblems
Upload Current Logo
*
Browse Files
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of
Predominant Strip Colour
*
Other Colours
*
Shorts Colour
*
Socks Colour
*
Upload Image of Strip:
*
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of
Alternate Strip
Predominant Colour
Other Colours
Shorts Colour
Sock Colour
Upload Image of Alternate Strip:
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of
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Is Your Organisation An Incorporated Body?
*
Yes
No
Summary of Balance Sheets (Must be Completed)
Income
*
Expenditure
*
Profit or Loss
*
Other Outstanding
*
Current Balance
*
Date Of Annual General Meeting
Last Meeting Date
*
-
Day
-
Month
Year
Date
Next Meeting Date
-
Day
-
Month
Year
Date
Please contact the office for any inquiries 4960 0967
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