BFA Player Agent Registration

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BOTSWANA FOOTBALL ASSOCIATION

2011 PLAYER-AGENT REGISTRATION NEW FORM


The completion of this form is required for registration in the Botswana Football Association
Program.

This form must be completed in its entirety and resubmitted annually.

NOTE:

I)

General (Please print or type)

Name: ___________________________________
I.D. #:

Date of Birth: ________________


Phone: (____) _______________

Home Address: ______________________________

Email Address: ______________

_____________________________________________________________
City
If affiliated with a particular firm or agency as a player-agent, please indicate:
Name of Firm/Agency: _______________________________________________________
Business Address: __________________________________________________________
__________________________________________________________(___)___________
City
Business Phone
__________________________________________________________(___)___________
E-Mail Address
Fax Number
II) Registration Information
Are you currently registered by FIFA as a player-agent?
Are you currently certified by the BFA ?

_______
Yes

________
Yes
______
No

_________
No

Permanent Provisional
(Circle one)

Names of any athletes (or all clients, if fewer than 10) you previously or currently
represent and, in team sports, the team/league to which each athlete is currently under contract and
name of team representative with whom you negotiated this contract. Write none if you currently do not
represent any athlete. If you represent athletes in more than one sport, please provide this information
for at least five clients (athletes) in each sport. Use additional sheets if necessary:
Player Name

Team

Clients Phone

Team Representative

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

I certify that the above information is true, correct and complete to the best of my knowledge. Further, I
certify that I will notify the BFA, Team management and Head Coach before the first contact with a soccer player
who has eligibility remaining in any sport and is a registered player or before the first
contact with the players-athletes family. I will not and/or have not engaged in any activity prior to a
player-athletes agreement to be represented that would otherwise jeopardize the player-athletes
eligibility.

Signature:

Date:____________________________

* Please send a copy of your registration if you are currently registered with the Botswana Football
Association.

Return Completed Form to:


Botswana Football Association
P.O. Box 1396
Gaborone
Work: (276) 3900279
Fax: (267) 3900280

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