GRASSROOTSOCCER & Kingfisher F.

M invite you & your family to:

THE

CORPORATE FUNDRAISING TOURNAMENT
Join us on Youth Day JUNE 16, 2011 in our 7v7 fundraiser! 9:30a.m – 4:00p.m.
Entry fee: R1,000/team
7 a-side
(inc. goalie)

@Victoria Park Sports Ground
REGISTER YOUR TEAM NOW!!
Contact Lizzy at 076 550 0013 or lkaroly@grassrootsoccer.org
Funds raised will support Grassroot Soccer’s HIV-prevention programs.

Prizes:Nike gear & apparel +
Raffle prizes:
Ipod, Beats by Dr Dre Head-set, World Cup encyclopedias, Nike gear & more!

max10 players/team Registration closes

Sunday, June 12

Using the power of soccer to educate, inspire, and mobilize the youth in the fight to stop the spread of HIV.
Visit us at www.grassrootsoccer.org

INSPI(RED) Soccer Corporate 7 v 7 FundraisingTournament
Mobilizing communities to stop the spread of HIV/AIDS.

16th June 2011. Victoria Park Sports Grounds.
Team Entry: R1000 per team (Register by June 12) TO CONFIRM YOUR ENTRY SUBMIT THIS FORM TO GRASSROOT SOCCER, R1,000 ENTRY FEE PLEASE CALL: 076 550 0013 OR 041 459 0047, OR lkaroly@grassrootsoccer.org Men and Women Welcome!
Company Name:_________________________ Team Manager:_________________________ Cell Phone:____________________________ VAT Number:__________________________ Company REG NO:______________________ Email:_________________________________

Person Responsible for Payment:
Full Name:_____________________________ Cell Phone:____________________________ Office Number:________________________ ID Number:_____________________________

Payment Method (please Tick one of the Following): Cash:____ EFT (electronic Funds transfer:____
By signing this form, the signatory ("the Signatory") hereto and the company (referred to above) ("the Company") confirm that they have read and are bound by the Terms & Conditions which are contained on page 2 of this form and that such Terms & Conditions have been brought to the attention of and accepted by the team ("the Team") referred to above and the players ("the Players") referred to hereunder
_______________________________ NAME OF COMPANY REPRESENTATIVE
_________________________________ ________________________ __________________

SIGNATURE OF COMPANY REPRESENTATIVE

IDENTITY NUMBER

DATE SIGNED

ALL TEAMS TO PROVIDE A COPY OF IDENTIFICATION OF THE PERSON RESPONSIBLE FOR REGISTRATION AND PAYMENT

Full Name 1 2 3 4 5 6 7 8 9 10

Cell phone Number

ID Number

Email Address

Payment Options for June 16th Inspi(RED) Tournament in Port Elizabeth, South Africa:

ENTRY FEE: R1,000 EFT
Electronic transfers must be made to our headquarters in Cape Town. Please be sure to indicate all of the following:     Company name Date of the event (16 June 2011) Inspi(RED) Fundraising Tournament Port Elizabeth, South Africa

Grassroot Soccer Banking Details: Bank: First National Bank Account Number: 62123913122 Account Type: Current Account Branch Code: 201809 Branch Name: Sea Point

Cash
For cash payments please contact us to arrange pick up or drop off of the entry fee. Receipt will be given.
Lizzy Karoly GRS PE Operations Cell: 076 550 0013 Office: 041 459 0047 lkaroly@grassrootsoccer.org

Tax Certificate Grassroot Soccer is a registered non-profit organisation. If you would like a tax certificate please email: lkaroly@grassrootsoccer.org P.O Box 71  New Brighton  Port Elizabeth 6200 South Africa (phone) +27 41 459 0007  (fax) +27 41 459 0047 Registration Number: 2006/010913/08 VAT Registration Number: 4650236385

TERMS & CONDITIONS By his / her signature hereto, the Signatory (on behalf of the Company, the Team and the Players), confirms that s/he –

1. is duly authorised to represent and sign for and on behalf of the Company, the Team and the Players; 2. authorises the team's entry into and participation in the Inspi(RED) Skillz Soccer Tournament on 16 June 2011 (“the Tournament”); 3. agrees that the Company, the Team and the Players are hereby deemed to have read, understood and agreed to be bound by the Tournament rules and regulations or other rules as may be prescribed by Grassroot Soccer South Africa (GRS) for the administration of the Tournament; 4. will be held responsible as co-principal debtor in solidum with the Company, the Team and the Players for the payment of any related fees in his/her personal capacity should the Company, the Team or the Players fail, neglect and/or refuse to pay the mandatory R1,000 Tournament fee payable by the Company, the Team, or the Players to GRS, which shall become due, owing and payable upon signature hereof; 5. acknowledges that the Team and any one or more or all of the Players may be banned from the Tournament, without refund, as determined by any one or more or all of the Relevant Parties whose decision as to such banning is final and whose rights remain fully reserved; 6. agrees that the Company, the Team and the Players have all agreed that in entering the Tournament, GRS accepts no liability, and will not be held responsible for any injury, damage or loss to property, including to the Tournament field and surrounding property, whether arising out of the negligence or otherwise, pursuant to the Company and/or the Team and/or the Players' entry into, attendance at and/or participation in the Tournament; 7. acknowledges that any individual whose name does not appear as a "Player" on the preceding page hereof may not participate in the Tournament on behalf of the Team and/or the Company and that GRS accepts no liability, and will not be held responsible for any injury, damage or loss to property whether arising out of the negligence or otherwise, pursuant to such individual's attendance at and/or purported participation in the Tournament; 8. agrees that the Company hereby indemnifies and holds GRS harmless from any claim which the Team and/or any one or more or all of the Players seek to enforce, notwithstanding 6 above, against any one or more or all of the Relevant Parties pursuant to the Team and/or the Player's entry into, attendance at and/or participation in the Tournament.

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