CHAIRMANS TROPHY FUTSAL CARNIVALE 2014

TEAM REGISTRATION FORM

Team Name:
Manager:

H/P No:

Captain:

H/P No:

Jersey
No.

Players
Name

Jersey Size

Designation

Mobile Number

IC Number

Staff
Number

1
2
3
4
5
6
7
8
9
10
** (Jersey No. must ONLY be from no. 1 10) **Please confirm jersey sizes by 8th October 2014**
We understand and agree to abide by all the rules and regulations as stated. We also confirm that details
regarding our registration form are correct. We hereby agree to participate in this Competition.
Yours truly,
Managers Name

: ___________________________

Managers Signature : ___________________________

The registration fee of RM800.00 per male team, RM600 per female & senior team can be made via
cash, cheque or direct bank-in to:
Account name: SYNERGYCENTRIC SDN BHD Account number: BMMB 1205-0003133-71-5
Received by: ________________________
Date: ______________________________
Submitted by: _______________________

Company Stamp