Derbyshire FA Request for New Club Membership

Please complete the form below to request a new club to be formed

Club Name*

Please tell us the name you would like to call the club? we will check if the name is in use we will inform you

Number of Teams*

Please tell us the number of teams you will set up under the club?

Leagues being joined*

Please tell us which league (s) you will be joining

Please list officials for forming the club

You must have 4 officials to form club, Chair / Secretary /Treasurer and a Club Welfare Officer. You must have a minimum of 2 people filling these roles. Please name them below

Secretary Name*

Please tell us the full name of the Club Secretary (First Name, Surname)

Secretary FAN*

Does this person have an FA Number?

Select

Secretary FAN YES*

Please provide the FAN Number

Secretary FAN NO*

Please go to https://wholegame.thefa.com/ and create a FAN When you have FAN list below

Secretary Email*

Please tell us the email address for the secretary

Secretary Phone Number*

Please tell us the best contact telephone number

Secretary Address*

Please tell us the Full Address for correspondence House number / name Street Town Postcode

Secretary Date of Birth*

Please tell us their Date of Birth

Chairperson Name*

Please tell us the full name of the Club Chairperson (First Name, Surname)

Chairperson FAN*

Does this person have an FA Number

Chairperson Email*

Please tell us the email address for the Chairperson

Chairperson Phone Number*

Please tell us the best contact telephone number

Chairperson Address*

Please tell us the Full Address for correspondence House number / name Street Town Postcode

Chairperson Date of Birth*

Please tell us their Date of Birth

Treasurer Name*

Please tell us the full name of the Club Treasurer (First Name, Surname)

Treasurer FAN*

Does this person have an FA Number

Treasurer Email*

Please tell us the email address for the treasurer

Treasurer Phone Number*

Please tell us the best contact telephone number

Treasurer Address*

Please tell us the Full Address for correspondence House number / name Street Town Postcode

Treasurer Date of Birth*

Please tell us their Date of Birth

Welfare Officer Name*

Please tell us the full name of the Club Welfare Officer (First Name, Surname)

Welfare Officer FAN*

Does this person have an FA Number

Welfare Officer Email*

Please tell us the email address for the Welfare Officer

Welfare Officer Phone Number*

Please tell us the best contact telephone number

Welfare Officer Address*

Please tell us the Full Address for correspondence House number / name Street Town Postcode

Welfare Officer Date of Birth*

Please tell us their Date of Birth

Club Upload Information*

Please upload your Club information here: Please include

Club Constitution
Minutes of the meeting that formed the Club
Budget forecast for the season
Club Bank Account Details

Drag and drop files here or

Confirmation*

I confirm that the information provided is correct to enable a new club to be formed (please check the box)

Send me a copy of my responses

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