Australia Cup Registration Form

Australia Cup Club Registration Form

This is the prescribed form for the Application for Registration of a Club (the Form) to participate in the Australia Cup. This Form must be duly completed, signed, and submitted to Football Australia (FA) to register the Club in accordance with the Australia Cup Competition Regulations and the National Registration, Status and Transfer Regulations (NRSTRs).

The Form must be received by FA for every year in which the Club competes and no later than 14 days prior to the first round of the Australia Cup in which the Club is scheduled to compete, including the Preliminary Rounds.

FA or its delegated Member Federation will use all reasonable endeavours to confirm registration within five (5) Business Days of receipt of a validly completed Form.

Capitalised terms used in this form have the same meaning as in the NRSTRs unless the context requires otherwise.

Club Details

Club Name*

Member Federation/Competition*

Club Logo(s)*

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Legal Entity Name*

ACN, ABN, Association No. (if applicable)

Club Office Address*

Address Line 1

Address Line 2

City

State

Postcode

Club Email*

Club Phone*

Club Primary Contact Information (Football Operations)

Name*

First Name

Middle Name (optional)

Last Name

Position in Club*

Phone*

Email*

Club Secondary Contact Information (Administration)

Name*

First Name

Middle Name (optional)

Last Name

Position in Club*

Phone*

Email*

Club Member Protection Information Officer (MPIO) Contact Information

Name*

First Name

Middle Name (optional)

Last Name

Phone*

Email*

Club Marketing Contact Information (where different from Football Operations contact)

Name

First Name

Middle Name (optional)

Last Name

Position in Club

Phone

Email

Club Media Contact Information (where different from Football Operations contact)

Name

First Name

Middle Name (optional)

Last Name

Position in Club

Phone

Email

Club acknowledgement of terms of registration

By completing, signing, and submitting this Form to Football Australia, the Club:

acknowledges that it, and its Players and Officials, agree to be bound by and comply with the FA Statutes, including the NRSTRs, the National Disciplinary Regulations, the National Code of Conduct and Ethics and any National Club Licensing Regulations, the AFC Statutes, and FIFA Statutes (as applicable);
agrees to be bound by and comply with the Australia Cup Competition Regulations (Regulations) including the payment of any prescribed Registration Fee as stipulated in the Regulations or as otherwise promulgated by FA or Member Federation from time to time;
must ensure that the Club and all of its Players and Officials are duly registered with FA in accordance with the Australia Cup Competition Regulations and the NRSTRs;
without limiting paragraphs 1 to 3 above:

a) grants to FA a licence to use the Club Marks (as that term is defined in the Regulations) in accordance with the Regulations; and

b) grants to FA a license to use the images of each Australia Cup Participant (as that term is defined in the Regulations) in accordance with the Regulations, and warrants that it has secured written confirmation from each Australia Cup Participant in respect to such use;

5. without limiting paragraphs 1 to 2 above, must comply with the Football Australia National Member Protection Framework, including but not limited to the Safeguarding Policy, which includes compliance with the relevant legislation and the completion of the appropriate validations for all Working with Children Checks, or state/territory equivalent, as required and in any timeframe or deadline prescribed by FA from time to time;

6. submits exclusively to the FA Grievance Procedure for the resolution of any Grievance in accordance with the FA Grievance Procedure By-Law;

7. without limiting paragraphs 1 to 2 above, must comply with all requirements and directions of FA and Sport Integrity Australia in relation to integrity matters, including education and anti-doping testing;

8. must agree to, and must procure that each Player and Official agrees to:

a)cooperate in good faith with all investigations conducted by, or at the direction of, FA in accordance with the FA Statutes;

b) provide assistance as required by FA with any investigation being conducted by, or at the direction of, FA in accordance with the FA Statutes; and

c) if requested by FA in accordance with the FA Statutes, produce documents related to any matter that is the subject of an investigation conducted in accordance with the FA Statutes;

9. agrees not to bring any claim against FA for any loss (including consequential loss) the Club, a Player, or an Official may suffer from the Club, a Player, or an Official participating in, or the Club, a Player, or an Official being excluded from participating in, the Australia Cup; and

10. warrants that the information provided on this Prescribed Form is current and correct as at the date of submission and that it will promptly notify FA of any changes and acknowledges that providing false or misleading information on this form may result in cancelation of registration.

PRIVACY COLLECTION STATEMENT

By completing this Form, the Club Official is providing personal information to Football Australia Limited (ACN 106 478 068) in order to register the Club with Football Australia in order to participate in the Australia Cup.

Football Australia respects the privacy of individuals about whom we collect personal information. The personal information that Football Australia collects via this Form is collected for the purposes of processing the Club’s Australia Cup registration, administering the game of football, sending the Club information regarding the Australia Cup and assisting with enquiries, providing the Club Official and the Club with direct marketing communications in relation to products, services, tickets, merchandise and special offers made available by Football Australia or our Football Australia Partners, and for other purposes set out in our Privacy Policy (http://www.footballaustralia.com.au/privacy).

The Club Official acknowledges that the information provided will be collected by Football Australia and may be disclosed to third parties for the purposes outlined above or as required by law. Such third parties may include Football Administrators (including Football Australia’s member federations, associations, and clubs as well as FIFA and the AFC), IT suppliers and event management organisations. Without the personal details, Football Australia can't register the Club to participate in the Australia Cup. The Football Australia Privacy Policy (http://www.footballaustralia.com.au/privacy) provides additional details, including how to contact Football Australia to access and correct the Clubs’ details or make a complaint.

By registering with Football Australia, the Club consents to the collection, use and disclosure of the personal information provided as described above and as set out in the Football Australia Privacy Policy (http://www.footballaustralia.com.au/privacy).

Signature*

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Name*

First Name

Middle Name (optional)

Last Name

Position of Authorised Representative at the Club*

Date*

THE CLUB WILL NOT BE REGISTERED TO PARTICIPATE IN THE AUSTRALIA CUP IF THIS FORM IS NOT DULY COMPLETED, SIGNED BY THE CLUB’S AUTHORISED REPRESENTATIVE AND SUBMITTED TO FOOTBALL AUSTRALIA.