* League:

* Team Name (Can be changed):

* Manager's Details:

* Secondary Team Contact:

* I can confirm that myself and all my players are 16 years of age or older:

* Signed (Full Name):

* Where Did You Hear About The League?

* If you were referred to the league by another team, please enter their team name here:

* I give permission for pictures and video footage to be taken of my team for future Norfolk FA/ FDC publicity and promotions: