REGISTRATION

Online Application

Notes on Completion

Online Application form must be submitted and payment received by 30th June for Senior Shield and Steel & Sons Cup entries, or 15th August for Junior Shield entry and last day of February for Women’s Challenge Cup.
A separate form must be submitted for each team.
Payment to include a £25 affiliation fee plus competition entry fee if applicable.
Once submitted the County Antrim FA Secretary must be notified in writing of any changes.
Affiliation is subject to approval of Council.

Team Details

Team Name:		Name of Ground :
League :		Address of Ground :
Colours :		Town :
Shirt :		Postcode :
Shorts :		Ground Telephone (if applicable):
Socks :
Is ground Private & Enclosed ?		Yes No

Secretary Details

Forename :		Address :
Surname :		Town :
Email :		Postcode :
Confirm Email :
Preferred Tel :
Alternative Tel :

Representative's Details		Same as Secretary's
Forename :		Address :
Surname :		Town :
		Postcode :

Competition Details
Competition :	Senior Shield (+£20.00)	Season :
	Junior Shield (+£10.00)
	Steel & Sons (+£10.00)
	Women’s Cup (+£10.00)
	Affiliation Only

Completed By :
Please select preferred method of payment:			BACS

* By submitting this form you agree to your name, postal address, contact number & email address being available to other Club Secretaries. Please check box to acknowledge.

* I confirm that the email address provided will be monitored regularly by club officials. Please note that this email address will used by the Co Antrim FA for ALL correspondence relating to Association business including notification of discipline and cup draws.

REGISTRATION

Notes on Completion

NAVIGATION

SPONSORS