NORTHAMPTON & DISTRICT YOUTH ALLIANCE FOOTBALL LEAGUE by KXj29n54

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									                                                    Berks & Bucks Football Association Limited
                                                                     League Application Form
                                                                       Season 2011 - 2012

   Name of Club

  Club Secretary:

      Address:

    Postal Code:                                              Telephone (Inc. STD Code)

  E-mail address:

 Ground Address:                                                                          Post Code
State each ground if
                                                                                          Post Code
  different teams.
    Do you have
  toilet/changing
   facilities, give
 details, if not state
 where nearest are


                     This form must be completed in full and returned to the League Secretary by Friday 3rd June
   FAILURE TO RETURN THE FORM BY THIS DATE IS TAKEN TO MEAN THAT YOUR CLUB HAS WITHDRAWN ITS MEMBERSHIP FROM THE
             LEAGUE. COST OF ENTERING 1 TEAM IS £40 THEN £30 FOR ANY ADDITIONAL TEAMS TO A MAXIMUM OF £125.
Strip Colours:

                                            Shirt                            Shorts        Socks
     First Strip

   Second Strip

State if teams play in different colours.



Name, Address & Telephone No. of all Club Officials:

           Position                          Name                        Email Address   Contact Number
          Chairman
          Treasurer
    Child Welfare Officer:
 Girls Football Co-ordinator


Registration Cards

Please confirm your registration cards for every team has been return
back to Chris Carr at the AGM. Failure to do so will result in a fine.
                                                  On behalf of the above Club, I wish to apply for membership to the Berkshire County Girls Football League for
                                                                           the season 2011 / 2012 and wish to enter the following teams:
  Age
Group /
          Number        Manager / Coach            Contact           Email         Pitch     1st aider    Team           Contact     Email Address      Ref /
             of         (Please state coaching     Number           Address         Size     (must have  Admin /        Number
 team
 name                        qualification)                                                      the
                                                                                                                                                       Official
          players                                                                             minimum
                                                                                                         Contact          ( incl.                     (Are they
             &                                                                                 of an in                  Mobile)                     qualified ?)
          School                                                                                              date
                                                                                                           emergency
          year in                                                                                              aid
          Sept 11                                                                                          certificate)
U8/U9

 U10

 U10

 U11

 U11

 U12

 U12

 U13

 U14

 U14

 U15

 U16

 U16


  If your team has a separate team administrator for contact to arrange matches etc please fill in the team Admin section, this will be printed in the league handbook and put on the website. The
league will be using the online Full Time system to report results, the team manager or administrator can do this but we must have their full details to assign them a logon. Alternatively a club may
                              prefer that their club secretary does the results for all teams. Please put (FULL TIME) next to the people who will need a full time logon.
I understand that my Club must be affiliated to the Berks and Bucks FA or their appropriate County Association for the season 2011 / 2012.

    County Assoc.                                                                                   Affiliation No.


   If my club is not affiliated to the Berks & Bucks FA I understand I must complete an out of County form which should be signed by my own county Girls &
   Women’s officer and returned with this League registration form. Out of County Form enclosed yes / no

   I have read and fully understand the league rules and agree to abide by them and hereby declare that neither my Club nor Club Officers & Officials are
   currently under suspension from the County Football Association.

        Signed:                                                                                    Club Secretary                       Date:

Please return this from before June 3rd 2011 to: Naomi Ball, Berks & Bucks FA, 15A London Street, Faringdon, OXON, SN7 7HD
Cheques should be made payable to: Berkshire County Girls Football League



                                             ***All New Applications Please Complete the section below: ***

 Previous League (if applicable)

 Where finished in Division                                                                                           A or B Division



Statistics:

         Played                     Won                     Drawn                  Lost              G/For                G/Agst.               Pts

								
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