Complete the below form if you require a refund from a Football Queensland affiliated club. Player Name* First Last Player FFA Number*Player Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Zone*ZoneBrisbaneCentral QueenslandNorth QueenslandGold CoastSunshine CoastSouth WestWide BayMackayNorth West QueenslandClub Name*Name of Club Official Submitting Request* First Last Position of Submitting Club Official*E-mail of Submitting Club Official* Submitting Club Offical Contact Number*Have you read the Refund of Governing Body Fees Policy to ensure your player is entitled to a refund?*YesNoHas the player participated in any form of training session (pre-season or in-season)?*YesNoHas the player participated in any form of team trials (formal or informal)?*YesNoHas the player participated in any form of player grading or selection processes?*YesNoHas the player participated in any pre-season matches, practice matches, official fixtures, or otherwise appeared on a match record for his or her club?*YesNoIs the De-Registration complete? i.e it has been approved by club/player and Zone*YesNoPlease provide the reason under the Refund of Governing Body Fees Policy that entitles your club to a refund (tick all that apply):* The Registration Status of the Amateur Player has been made “Active” in the National Online Registration System in accordance with the National Registration Regulations The Amateur Player has not participated in any form of training session (pre-season or in-season), team trials (formal or informal), player grading or selection processes, pre-season matches, practice matches, official fixtures, or otherwise appeared on a match record for his or her club The Amateur Player or their Club has applied for de-registration via the National Online Registration System in accordance with the National Registration Regulations and Registration/De-Registration Periods notified by Football Queensland None of the above reasons are applicable Please provide the reason for the De-Registration Request*Please provide the reason for the De-Registration RequestWanted to try another activity or sportInjurySchool Sport CommitmentsStudy CommitmentsConsent* I, on behalf of the club, agree that all of the above information is true and correct*
