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Local Futsal Club Affiliation

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Application

Fill our the below application form to submit your affiliation request.

What happens next?

Your application will be reviewed by Football NSW. If your application is approved, you will receive a affiliation package supplied by Football NSW.

"*" indicates required fields

1. Application Process
The Application Process to seek Football NSW endorsement of Community Futsal Competition comprises; Competition Information; and Terms and Conditions. Both of these processes are combined in this document.
Prospective Community/Local Futsal Competition Administrators are required to submit this document having answered all questions and executed where required.
Upon approval, Football NSW will confirm the agreement with a confirmation letter and return to the Competition Administrator.
2. Submission
Each Applicant is required to complete this application process:
This form must be completed by an authorised person of the Applicant.
By submitting the form, the Applicant will be deemed to have reviewed, acknowledged and agreed to the terms and conditions set out in the form without reservation or variation.
Should you require any assistance in completing this form please contact the following Football NSW employee:
Jordan Guerreiro
Email: jordang@footballnsw.com.au
Telephone: (02) 8814 4465

Name of Applicant (i.e legal entity name)*

ABN of Applicant*

Please confirm the Applicant's legal structure:*

ACN/INC Number of Applicant*

Contact Person of Applicant*

First Last

Contact Person Phone Number (mobile)*

Contact Person Phone Number (office)

Applicant's Club Logo*

Max. file size: 18 MB.

Name of Club President*

List of Member of the Applicant’s Club Committee*

How many club members does the Applicant have?*

Please upload a copy of the Applicant's Futsal Club development plan (covering the next three years)*

Max. file size: 18 MB.

Applicant's Nominated Home Venue Name*

Venue Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Courts at Applicant's Nominated Venue*

Is the applicant linked to any other clubs or associations? (please specify)*

Applicant's Website*

Please ensure you include the following format when entering 'http://www....

Applicant's Member Protection Information Officer Name*

Applicant's Member Protection Information Officer Contact Email Address*

Enter Email Confirm Email

Acknowledgement

I hereby acknowledge that I have carefully read and fully understand the terms and conditions set out in this Endorsement Agreement. Clicking “Yes” constitutes the Applicant's electronic acceptance of a legally binding contract between the Applicant and Football NSW Limited, enforceable in accordance with the applicable laws.*

First Last

Insert your name

In my capacity as*

Insert title)

READ HERE

I have read and agreed to the above terms and conditions:*

Yes - I have read and agreed to the above terms and conditions:

I also acknowledge and agree to the following: I am a person who is authorised to sign this form on behalf of the Administrator; the Administrator agrees to comply with the requirements and obligations set out in this form; on behalf of the Administrator, I have read and understood the form in relation to the Futsal Local Centre structure; and on behalf of the Administrator, I have completed this form to the best of my knowledge and ability and the contents of my submission are true and correct.

Digital Signiture*
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