SPORTS CLUB

REGISTRATION FORM

in2sport@brimbank.vic.gov.au

or Leisure Services

PO Box 70, Sunshine, Victoria 3020

For more information please call Leisure Services on

Registered name:

Contact person:

Correspondence address:

Phone:

Mobile:

Email:

Incorporation number:

ABN:

Registered for GST:

Yes

No

BSB:

Bank ac

count:

Junior membership fees:

(Please provide information regarding the club’s current junior membership fee structure)

I agree that I have the authority to make this application on behalf of the above named organisation.

I understand that when registering to be an In2Sport Brimbank Club, the above named organisation will receive 75% of membership costs,

with a maximum of $200 per successful applicant (subject to budget availability) upon invoicing the Brimbank City Council.

Clubs are not allowed to charge full membership fees for In2Sport approved applicants and reimburse these applicants at a later stage;

clubs are only allowed to charge the membership fee minus the approved funding per applicant.

Only previously agreed fees for each applicant can be claimed.

Fees are only for the nominated registered season.

No retrospective fees will be paid.

All invoices relating to the summer application period have to be submitted before 30 Jan 2023 and all invoices relating to the winter

application period have to be submitted before 1 May 2023 to receive Council funding.

Clubs agree that fees will only be paid to the club if there is active sporting season.

Clubs agree to having their membership fees publicised on Council’s website and other publication forms relating to In2Sport Brimbank.

Clubs agree to provide a welcoming and inclusive environment to all applicants regardless of their cultural background, gender or abilities.

Name:

Position on Committee:

SIGNATURE:

D

ATE:

241 - 0722