SFA-C01A FORM

PERSATUAN FLOORBALL
NEGERI SELANGOR
(No. Ruj. 7052/2014)

CLUB REGISTRATION FORM

Ref. no:

CLUB NAME:

Date:
Manager
Signature:

Address: No. 24, Jalan 10/3, Taman Putra, 68000 Ampang, Selangor Darul Ehsan

Contact: +6 017 237 3940

Email: selangorfloorball@yahoo.com

INSTRUCTIONS
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All fields are complusory to be filled up in CAPITAL LETTERS, except for those under "For SFA use only".
Players to signed in Form SFA - C01A shall be bounded to the club named aboved and shall abide to the SFA constitution, bylaws rules and regulation.
Designation: M = Manager; AM = Assistant Manager; C = Coach; GK = Goalkeeper.
To cross out unused rows, if any.
Two (2) copies of SFA -C01A must be submitted. i) Hard copy (with players signature) with other forms and all payments by hand; ii) Softcopy via email.
Name (as per NRIC/ Passport)

Gender
( F/ M )

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NRIC/ Passport / Birth

Certificate No

Age

Players'
Signature

Designation
( M / AM / C / GK )

Form
(ref. no).

For SFA use only

New Late
Remark
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