SFA-T01 FORM

PERSATUAN FLOORBALL Ref. no: STA-C01

NEGERI SELANGOR
(No. Ruj. 7052/2014)
Register Status Year:
TEAM REGISTRATION FORM New On time Late 1 Late 2

TEAM INFORMATION

Team name:

Tournament / Event:

Affiliates
Team colors: No. of players: Date establish: Category:
(school/university/company):
(MALE / FEMALE / MIX)
Level: ( SCHOOLS / VARSITY / OPEN )

Mailing Address:

Manager full name: Manager mobile phone no.: Team / Manager e-mail address:
Manager NRIC or passport no.: Nationality:

Assistant manager full name: Assistant manager mobile phone no.: Assistant manager NRIC or passport no.:
Nationality:

Coach full name: Coach mobile phone no.: Coach e-mail address:
Coach NRIC or passport no.: Nationality:

TEAM DECLARATION
I, (manager full name) , (NRIC or Passport no)
As the manager of the team as stated above, declare on behalf of the club that:
All information provided in form SFA-T01 & SFA-T01A is true and complete to the best of my knowledge and belief.
I undertake that, by registering the team to the event organized by Selangor Floorball Association (SFA), the team and
all the registered players attached to the team shall abide the rules made according to the rules and regulations of the
tournament.
I undertake that, SFA, the committee members and relevant associate party of SFA will not be hold responsible for any
unforeseen incidents or mishaps that may occur to all registered players of the team while participating in any events of
SFA or SFA endorsed events.

(Manager signature) : (Date) (DD/MM/YY) : (Payment amount) :

For SFA use only Register Status Checklist

TEAM FEE RM Within transfer window N.A Early registration 0 RM 250

TEAM PENALTY RM Transfer window N.A New registration 00 N.A

GRAND TOTAL RM New club N.A Late registration 1 N.A

RECEIPT NO Returning club N.A Late registration 2 N.A

DATE Recurring club N.A

SIGNATURE Last Register Year N.A
[PRESIDENT]
Approve / Reject Date:
SIGNATURE
[HON. SECRETARY] Total player forms submitted N.A Reason of rejection :

Total player registered pax

Total late registered player N.A