Rotary (District 1220) Inter District Football Tournament, 2016

Registration Form

PLEASE NOTE: The national competition is organised such that each District can enter one
team into the Final, if you want any more information contact your District Youth Services Chair.

(Please complete the following and return the completed form with
cheque for £15 to:

Rtn Rod Gent, by dates stated 4 Fox Lane, Alrewas, Burton upon Trent,
Staffordshire, DE13 7ER)

District Number / Club Name

Name of Rotarian Contact
Contact Telephone numbers and
email address
Name of Team entering
Boys / girls / mixed

I have read and agree to be bound by the tournament Rules.

I attach a cheque in the sum of £15, registration fee, payable to

“Rotary International District 1220”

Signed ….....................................

Rotary Club of ….....................................

I confirm that this is the registration for District ……………

Signed …………………………….
District Youth Chair

Signed …………………………….
District Governor

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 Rotary (District 1220) Inter District Football Tournament, 2016
Registration Form
Rotary Inter-District Under 12s Football Competition
5th June 2016
Venue: F.A. Centre St. George’s Park, Burton upon Trent

DISTRICT:

Rotarian contact:

Team Name:

Manager:

First Aider:

Players Name Date of Birth

10

Registration forms to be received by 31st May 2016

Return to: Rtn Rod Gent, 4 Fox Lane, Alrewas, Burton upon Trent, Staffordshire DE13 7 EG

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Name of Club Age Groups Name and Name of County
participating in Address of County Association
the Secretary Association to Affiliation
Competition which the Club Number
belongs 2015/2016

Jan 2016 v.1