Sports Club Registration Form

Burger KinG Choose Sport Sports Club Registration Form

Name of Sports Club - Must be same as bank account *

Name of Regional and/or National Body to which you are affiliated *

Is your organisation Non-Profit body? *

Yes

Mailing Address *

Street Address *

Main Contact Person *

Position in Club *

Approved Referers

Please provide the Name, Position in Club, Email and Phone of the referrers. Failure to complete this information may result in your registration being denied.

Referrer 1) *

Referrer 2) *

Referrer 3) *

Referrer 4) *

Declaration

We agree to comply with a request from an officer of the Department of Internal Affairs or an appointee of the Kolmar Charitable Trust for information in relation to the receipt and use of the grant monies paid to this organisation.We agree that an officer of the Department of Internal Affairs or an appointee of the Kolmar Charitable Trust may direct an audit or inspection of the books,accounts or data systems in which the receipt of the grant monies have been deposited. We further agree that any information requested will be provided in a timely manner. We agree to refund amounts if the audit criteria is not satisfied.We hereby consent to the above audit conditions and certify that the information included in this registration together with any supporting details is true and correct.We certify that we have authority to complete this registration on behalf of the club.