Club Registration Form 2004
 

By filling in this form I understand that I will become a registered member of Salford Victoria FC and as such agree to abide by the rules and regulations set down by The Management Committee of the Club.

Read the: Club Code of Conduct and Discipline Procedures any amendments during the season will be put up on the notice board in the clubhouse. It is the player’s responsibility to make sure they are fully aware of the rules and possible fines that may be incurred.

Your Full Name:
*
Your Home Address:
*
Your E-mail Address: *
Position:

Goalkeeper
Defender
Midfield
Forward
Other
Non-playing skills:

Coach
Administration
Fundraising
Other
Date of Birth:
*
Home Tel No:
*
Mobile No:
Medical Details:

(Please indicate if you have any medical conditions we should be aware of e.g. asthma)

Emergency Contact Details: *

(Please include thier contact number)

All fields marked with * are required