THE SOUTH STAFFORDSHIRE JUNIOR CHARITY COMPETITION
APPLICATION FORM 2010-2011 SEASON
Complete and return to: David Vale 24 Deakin Avenue, Brownhills,
West Midlands WS8 7QA. Phone 01543 372414.: mob: 07855 400825
e-mail : e.vale@sky.com
Name of Club
Name and address
of Club Secretary:
Post Code
Telephone Number:
Mobile Number:
E-mail address:
Fax Number:
Home Ground:
Colours:
Which FA are you affiliated to season 2010-11
Affiliation Number.
Have you got permission from your league to enter:
In which league do you play:
Enter which age group and number of teams: Under11:
Under 12:
Under 13:
Under 14:
PLEASE LIST “TEAM NAMES” FOR MULTIPLE ENTRIES
on the back of this form e.g U14 Reds – U14 Ravens etc.
ALL correspondence will only be sent to Club Secretary as per League Handbooks.
The following declaration must be signed before returning the form:
We
(Chairman) and
(Secretary) of
FC. Agree to abide by the rules of
the competition subject to the right of appeal to the Staffordshire County FA Ltd.
The Conference Dates for the competition will be the first Sunday in each month commencing October.
THE FINALS WILL BE PLAYED OVER THE MAY DAY BANK HOLIDAY WEEK-END
This form together with entrance fee of £10.00 per team (non refundable)
should be returned NO later than 31st July 2010. To David Vale.
CHEQUES SHOULD BE MADE PAYABLE TO:
SOUTH STAFFORDSHIRE JUNIOR CHARITY COMPETITION.