2020 Nike FC Cup Registration Form

1
Club Name* This field is required.
2
Current League of Team* This field is required.
NPLW
VPL Womens
WSL 1
WSL 2
WSL 3
WSL 4
WSL 5
Regional Affiliate
3
Club Contact Name* This field is required.
First Name
Last Name
4
Position at Club?* This field is required.
President
Secretary
Treasurer
Other
5
Email* This field is required.
example@example.com
6
Contact Number* This field is required.
7
Playing Strip Information* This field is required.
Home Playing Shirt
Away Playing Shirt
Home Playing Shorts
Away Playing Shorts
Home Playing Socks
Away Playing Socks
8
Name of Home Venue* This field is required.
9
Please select the relevant rounds your Club's Home Venue is available to host fixtures OR select 'Other' and provide a reason if you are unable to host.* This field is required.
Qualifying Round 1 - 22nd March
Round 1 - 29th March
Round 2 - 5th April
Round 3 - Mid-Week between 12th -19th April
Round 4 - Mid-Week between 31st May - 7th June
Quarter Final - Mid-Week between 28th June - 5th July
No Access
10
Does your club have approval from the Venue Owner (i.e Council) to host Cup Fixtures prior to the regular season commencement?* This field is required.
Yes
No
Private Venue
Awaiting Confirmation
11
* This field is required.If yes, please attach council approval in writing
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
12
Would your club be available to host Cup fixtures other than your own, subject to council approval?* This field is required.
Yes
No
Unsure at this Stage
13
Terms & Conditions

a) I am authorised to submit this form on behalf of the Club;

b) The information provided is correct and accurate as of the submission date. If there are any changes to the informaiton supplied, I will inform Football Victoria Competitions via email at competitions@footballvictoria.com.au;

c) by participating in the Nike FC Cup, the Club shall be bound by the Nike FC Cup Regulations as promulgated by Football Victoria from time to time.

d) I acknowledge that the club will be charged a team entry fee of $110 (incl. GST) through the Club Finance System.
14
Do you acknowledge and agree to the above terms?* This field is required.
Yes
Should be Empty:

Save your progress

Save your progress

Your form submission has been saved as a draft.

Save your progress

Your form submission has been saved as a draft.