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NSW Floorball
Membership form

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Membership Form

Please use BLOCK LETTERS and answer all questions

Please also not any medical condition which may affect your play

Name:                                                                                                                                                                                                                                                            Sex:

 

Male

Female

Address:                                                                                                                                                                                                                                          

 

 

Ph/Fax/Mobile:

 

 

Email address:

 

Occupation/School:

 

Club name:

 

Category of commitment to the NSW Floorball League: (please circle applicable boxes)

NSW Floorball League

AFA member

Coach

 

Announcer

Promotions

Otherplease specify

Player

Scorer

$ collector

Coach

Referee

Volunteer

Signature (of player or parent/guardian) agree to pay full fees:

 

day

mth

2002

Office Use only

Date received

Amt AFA fees

Match fees

Receipt #

initial

 

      /      /2002