Brisbane Magic Futsal 2010 / 11 Registration Details

The much anticipated 2010 / 11 Futsal season begins in September and the sign on will take place on
Sunday 28 August between 10am and 2pm
Sunday 4 September between 10am and 2pm
Sunday 11 September between 10am and 2pm
at the State Hockey Centre, 400 - 420 Lytton Road, Colmslie

Click here for Team Registration Form
Click here for Football Queensland Player Age Policy

ALL PLAYERS ARE TO PRODUCE IDENTIFICATION WITH DATE OF BIRTH. 

REGISTRATION OF
AMATEUR PLAYER
Prescribed Form NRR03
 
1. Have you registered with FFA Previously ? YES NO
If Yes, please write your FFA Registration Number
 
PARENT DETAILS
(To be completed if player is under the age of 18 years)
PLAYER DETAILS
2. Title
3. First Name
Middle Name
Surname
4. Date Of Birth
5. Age group appiled for
6. Gender Male Female
7. Address
Suburb
State
Post Code
8. Country of Birth
9. Nationality
10. Are you aboriginal or Torres Strait islander? YES NO
11. Player contact phone/email(please provide at least one phone number)
12. Emergency Contact
(name)
(phone)
(mobile)
 
18. Parent/legal guardian
Title
First Name
Middle Name
Surname
Gender Male Female
Contact phone/email(please provide at least one phone number)
SCHOOL DETAILS
19. Are you a student? YES NO
20. If under 18 years of age and at school, please provide namae of school
21. Do you play for the school team? YES NO
22. Media YES NO
By ticking yes to the above, you provide consent to QFL & FQ to use any images/video of you from this competition and allow QFL & FQto display these images for the purpose of marketing, advertising or promotion in any manner it may see fit. In the event that you not wish to provide consent, please tick the NO box provided above.
SIGNING
The Club and the Player as listed above apply to Football Federation Australia Limited to register the Player with that Club as an AMATEUR PLAYER.
By signing this form, the Player(or if the Player is under 18 years of age at the time of signing this form, that Player's parent or legal guardian) agrees to comply with the Terms and its incorporated documents, including the FFA Statutes and Spectator Code of Behaviour.
(Name of Player or Parent/Legal Guardian) (Date)
 
REGISTRATION DETAILS
13. Name of club
Name of team playing for
14. Registering to Play
15. Previous national association
(If the previous national association was based overeas, FFA must obtain an International Transfer Certificate)
16. Previous Club
17. Are you currently under suspension?
if Yes, how many matches/weeks remaining
Name of football organisation which issued the suspension?
 
 
I understand that I am not Fully Registered until Payment is made to Brisbane Magic Futsal