EGFNL & BDJFA

INTERCHANGE FORM A 2009

PLAYER'S NAME: ____________________________________________

DATE OF BIRTH: ______________________

ADDRESS: ___________________________________________________

CONTACT PHONE NUMBER: ____________________________

DO HEREBY apply for permission to play with the

_______________________ FC for

Round:______________ to be played on the ______/______/2009.

EGFNL Grade that the player has been selected to play:

Seniors/Reserves/Under 18s. (Circle one)

Are you presently under disqualification for a misdemeanour or financial reasons?

(Yes/No)

Player Signature ___________________________________   Date ______/______/09.

Parent /Guardian Signature ____________________________  Date______/______/09.

(Parents Signature is required)

CLUB (with which the Player is currently registered)

The Applicant is a registered player of the ___________________________

Football Club affiliated with the Bairnsdale District Junior Football Association

and IS / IS NOT (Circle) under disqualification for any misdemeanour or financial reasons.

AND THIS CLUB hereby APPROVES this application.

BDJFA Club Coach Signature: (Required)

________________________________ Date: ________

BDJFA Club President/Secretary Signature: (Required)

___________________________________ Date: _________
On completion this form is to be placed in the Match Day envelope.