Wexford & District Schoolboys LeagueAffiliated to the SFAI and FAI

Application for Membership Season 2019/2020BLOCK CAPITALS (Please fill in all the form)

COPY OF CLUBS PUBLIC LIABILITY INSURANCE MUST ACCOMPANY THIS FORM

Club: ............................................................................ Location of Ground: .............................................................................................

No. of Teams: 9s ................ 10s................ 11s…….....… 12s.…….....… 13s.….....…… 14s.…….....…. 15s….....…… 16s….....……

Colours: 9s .............................................................................................................../...................................................................................

Colours: 10s ............................................................................................................./...................................................................................

Colours: 11s ............................................................................................................./...................................................................................

Colours: 12s ............................................................................................................./...................................................................................

Colours: 13s ............................................................................................................./...................................................................................

Colours: 14s ............................................................................................................./...................................................................................

Colours: 15s ............................................................................................................./...................................................................................

Colours: 16s ............................................................................................................./...................................................................................Please fill in Names, Address & mobile phone numbers

BLOCK CAPITALSChairman: ........................................................................................................................Tel:

Vice Chairman: ................................................................................................................Tel:

Secretary (Schoolboys): ................................................................................................................................................................................

Contact Email: .......................................................................................................Tel:

Treasurer: ........................................................................................................................Tel:

(COMPULSORY) Registrar: ............................................................................................Tel:

Please fill in ALL Team Managers Names & Phone numbersBLOCK CAPITALS

9s...................................................................................................................................................................................................................

10s.................................................................................................................................................................................................................

11s .................................................................................................................................................................................................................

12s.................................................................................................................................................................................................................

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14s.................................................................................................................................................................................................................

15s.................................................................................................................................................................................................................

16s.................................................................................................................................................................................................................IMPORTANT: Please tick box to grant permission to use information on WDSL website.

Please fill in Name, Address & Phone number of Child Protection OfficerBLOCK CAPITALS....................................................................................................................................................................................................................................................................................

.........................................................................................................................................Tel: The Club Secretary must complete (IN BLOCK CAPITALS) and return to the League Secretary by 20th September, 2019

Total €……………………(Affiliation Fee) Signed………………………………………………Club Secretary

AFFILIATION FEES: Per Club: 1-5 teams €350 • 6-10 teams €400 • Over 10 teams €450 + €5 per child registeredAFFILIATION FEES TO bE SENT TO ThE LEAGuE TREASuRER (M. CARThy, 40 KING ST., WExFORD), bEFORE START OF SEASON