1. SHROPSHIRE FOOTBALL ASSOCIATION COURSE APPLICATION
FA LEVEL 2 BLOCK 1 – How We Coach
Price - £49 Charter Standard Clubs £59 Non Charter Standard Clubs
MAY SHREWSBURY
Tuesday rd May, 6.00pm – 9.30pm
Wednesday 24th May, 6.00pm – 9.30pm
Tuesday th May, 6.00pm – 9.30pm
Wednesday 31 May, pm – 9.30pm
Saturday 3rd June, 9.00am – 5.00pm
Sunday th June, 9.00am – 5.00pm
Name of Attendee: _________________________________ Title______
Address: _______________________________________________________________
_______________________________________________________________________
_____________________________________Post Code_________________________
Gender Male/Female FAN (if known): _____________________
Date of Birth______________________________
Tel No: (Home) ___________________________Tel No: (Day)____________________
Emergency No:___________________________________________ (Wife, Partner etc)
__________________________________________________________________
CLUB:
ALL CONFIRMATION AND DETAILS WILL BE SENT BY
Signature of Attendee ______________________________________________________
Methods of Payment:
Cheque made payable to Shropshire FA
If you wish to pay by credit/debit card, complete the information below and either post the form to the address below or telephone the SFA on
Cardholder Name:……………………………………………………
Card Number (16 digits) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Start Date: _ _ / _ _
End Date: _ _ / _ _ Post Code ……………………
3 Digit Security Number: _ _ _
Shropshire Football Association, Oteley Road, Shrewsbury. SY2 6ST

2. Signed……………………………….. Date……………………………………
Ethnicity – I would describe my ethnic origin as:
Disability – Do you consider yourself to have a disability? Yes / No / Prefer not to say
If Yes, what is the nature of your disability? (Please circle)
Hearing Multiple Mobility Other
Learning Visual Physical Prefer not to say
Please tick this box if you do not want to receive information from Shropshire FA
Please state any condition(s) requiring medication e.g. Asthma_______________
Please tick if you have an FA first aid qualification____________
Please tick if you have a ‘FA safeguarding children’ certificate______________(Proof will be required)
I understand that the course I am applying for will require me to participate as a coach and player and I confirm that I am physically prepared to participate YES/ NO
I accept that Shropshire Football Association cannot be held responsible for any loss or injury I may sustain whilst taking part in this course.
Signed………………………………..
Date……………………………………
Rules and Conditions:
Cancellations must be received no later than 48hrs before the start of the course by either letter or or the full charge will be payable.
Refunds will not be issued after this deadline. All courses are subject to participants numbers.
In the event of a course being cancelled you will be contacted no later than 48hrs before the course is due to run. In the event of this full refunds will be given.
Data Protection
The information provided by the applicant will be used solely for the purposes of the Shropshire Football Association.
Please complete this form and return with your cheque/invoice address to:
Coach Education Department
Shropshire Football Association,
Oteley Road, Shrewsbury. SY26ST
Cheques payable to “Shropshire Football Association’
Please write ‘Coach Ed’ on back of cheque.
CLOSING DATE: 1 WEEK PRIOR TO START OF COURSE