Request for Game Deferral

Club Name*

Name of Person Submitting Form*

First Last

Authorising Persons Club Position*

Contact Phone*

Authorising Person Club Email Address*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Opposition Club Name*

Competition*

Untitled*

Date of Game*

Game Venue*

Kick-Off Time*

:

Reason for Deferral*

Instructions for Deferrals All deferrals submitted prior to the commencement of the season will be accepted. Deferrals submitted after round 1 will be tabled to the Board to approve or decline.

Verification*

Please enter any two digits

Contact details

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