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*
Date of Game*
DD slash MM slash YYYY
Game Venue*
Kick-Off Time*
: Hours
Minutes
AM/PM
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