Derbyshire FA Request for New Club Membership

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

 

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

 

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

 

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

 

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

 

Does this person have an FA Number?

 

Please tell us the email address for the secretary

 

Please tell us the best contact telephone number

 

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

 

Please tell us their Date of Birth

 

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

 

Does this person have an FA Number

 

Please tell us the email address for the Chairperson

 

Please tell us the best contact telephone number

 

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

 

Please tell us their Date of Birth

 

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

 

Does this person have an FA Number

 

Please tell us the email address for the treasurer

 

Please tell us the best contact telephone number

 

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

 

Please tell us their Date of Birth

 

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

 

Does this person have an FA Number

 

Please tell us the email address for the Welfare Officer

 

Please tell us the best contact telephone number

 

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

 

Please tell us their Date of Birth

 

Please upload your Club information here: Please include

  1. Club Constitution
  2. Minutes of the meeting that formed the Club
  3. Budget forecast for the season
  4. Club Bank Account Details
Drop your files here
 

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