M A L T A

F O O T B A L L

A S S O C I A T I O N

FO RM ' N'
NOMINATION OF COUNCIL MEMBERS FOR THE YEAR 2012/2013 BY MEMBER CLUBS AND MEMBER ASSOCIATIONS
(To be sent to the General Secretary of the Malta Football Association by not later than Tuesday, 26th June 2012)

Member Club / Member Association*:

We, the undersigned, on behalf of the above mentioned Member Club/Member Association*, wish to nominate the under mentioned person to act as a Council Member representing the said Member Club/Member Association* during the year 2012/2013. We confirm that this appointment implies that the nominated person shall be subject to jurisdiction and to all the rules, byelaws and regulations of the Malta Football Association and of those other international organisations of which the Malta Football Association may be a member. Furthermore, in view of the Data Protection Act (Chapter 440 of the Laws of Malta), we confirm that the under mentioned person has given his unconditional consent to the Malta Football Association to store and process the information appearing on this Form in any manner in which it may deem fit and proper, to share such information with its Member Clubs, Member Associations, its employees and with other individuals and organisations as may be necessary and that the Malta Football Association may continue to keep such information until such person would have informed it in writing of his resignation as a Council Member representing the above mentioned Member Club/Member Association* provided that on such resignation such person would have fulfilled all his obligations towards the Malta Football Association. *Delete as necessary

DETAILS ABOUT NOMINATED COUNCIL MEMBER

Name and Surname:

Address:

Govt. I.D. Card No

Date of Birth:

Telephone No Residence:

Telephone No Business:

Mobile Phone No

E-Mail:

Signature of PRESIDENT:

Signature of HON. SECRETARY:

Date:

/ 2012