GRASSROOTSOCCER & Kingfisher F.

M invite you & your family to:

THE

CORPORATE FUNDRAISING TOURNAMENT

Join us on Youth Day JUNE 16, 2011 in our 7v7 fundraiser!

9:30a.m – 4:00p.m.
Entry fee: @Victoria Park Sports Ground Prizes:Nike gear
R1,000/team & apparel +
7 a-side (inc. goalie) REGISTER YOUR TEAM NOW!! Raffle prizes:
max10 players/team Contact Lizzy at 076 550 0013 or lkaroly@grassrootsoccer.org Ipod, Beats by Dr Dre
Registration closes Head-set, World Cup
encyclopedias, Nike
Sunday, June 12 Funds raised will support Grassroot Soccer’s HIV-prevention programs. gear & more!

Using the power of soccer to educate, inspire, and mobilize the youth in the fight to stop the spread of HIV.

Visit us at www.grassrootsoccer.org
 INSPI(RED) Soccer Corporate 7 v 7 FundraisingTournament
Mobilizing communities to stop the spread of HIV/AIDS.
16th June 2011. Victoria Park Sports Grounds.
Team
TO CONFIRM YOUR Entry:
ENTRY R1000
SUBMIT per team
THIS FORM (Register SOCCER,
TO GRASSROOT by JuneR1,000
12) ENTRY FEE
PLEASE CALL: 076 550 0013 OR 041 459 0047, OR lkaroly@grassrootsoccer.org
Men and Women Welcome!

Company Name:_________________________ VAT Number:__________________________

Team Manager:_________________________ Company REG NO:______________________

Cell Phone:____________________________ Email:_________________________________

Person Responsible for Payment:

Full Name:_____________________________ Office Number:________________________

Cell Phone:____________________________ ID Number:_____________________________

Payment Method (please Tick one of the Following): Cash:____ EFT (electronic Funds transfer:____

By signing this form, the signatory ("the Signatory") hereto and the company (referred to above) ("the Company") confirm that they have read and
are bound by the Terms & Conditions which are contained on page 2 of this form and that such Terms & Conditions have been brought to the
attention of and accepted by the team ("the Team") referred to above and the players ("the Players") referred to hereunder

_______________________________ _________________________________ ________________________ __________________

NAME OF COMPANY REPRESENTATIVE SIGNATURE OF COMPANY REPRESENTATIVE IDENTITY NUMBER DATE SIGNED

ALL TEAMS TO PROVIDE A COPY OF IDENTIFICATION OF THE PERSON RESPONSIBLE FOR REGISTRATION AND PAYMENT
Cell phone
Full Name ID Number Email Address
Number

10
Payment Options for June 16th Inspi(RED) Tournament in Port Elizabeth, South Africa:

ENTRY FEE: R1,000

EFT
Electronic transfers must be made to our headquarters in Cape Town. Please be sure to
indicate all of the following:
 Company name
 Date of the event (16 June 2011)
 Inspi(RED) Fundraising Tournament
 Port Elizabeth, South Africa

Grassroot Soccer Banking Details:

Bank: First National Bank
Account Number: 62123913122
Account Type: Current Account
Branch Code: 201809
Branch Name: Sea Point

Cash
For cash payments please contact us to arrange pick up or drop off of the entry fee. Receipt will
be given.
Lizzy Karoly
GRS PE Operations
Cell: 076 550 0013
Office: 041 459 0047
lkaroly@grassrootsoccer.org

Tax Certificate

Grassroot Soccer is a registered non-profit organisation. If you would like a tax certificate please
email: lkaroly@grassrootsoccer.org

P.O Box 71  New Brighton  Port Elizabeth 6200 South Africa

(phone) +27 41 459 0007  (fax) +27 41 459 0047
Registration Number: 2006/010913/08
VAT Registration Number: 4650236385
TERMS & CONDITIONS

By his / her signature hereto, the Signatory (on behalf of the Company, the Team and the
Players), confirms that s/he –

1. is duly authorised to represent and sign for and on behalf of the Company, the Team and
the Players;

2. authorises the team's entry into and participation in the Inspi(RED) Skillz Soccer
Tournament on 16 June 2011 (“the Tournament”);

3. agrees that the Company, the Team and the Players are hereby deemed to have read,
understood and agreed to be bound by the Tournament rules and regulations or other
rules as may be prescribed by Grassroot Soccer South Africa (GRS) for the administration
of the Tournament;

4. will be held responsible as co-principal debtor in solidum with the Company, the Team and
the Players for the payment of any related fees in his/her personal capacity should the
Company, the Team or the Players fail, neglect and/or refuse to pay the mandatory R1,000
Tournament fee payable by the Company, the Team, or the Players to GRS, which shall
become due, owing and payable upon signature hereof;

5. acknowledges that the Team and any one or more or all of the Players may be banned
from the Tournament, without refund, as determined by any one or more or all of the
Relevant Parties whose decision as to such banning is final and whose rights remain fully
reserved;

6. agrees that the Company, the Team and the Players have all agreed that in entering the
Tournament, GRS accepts no liability, and will not be held responsible for any injury,
damage or loss to property, including to the Tournament field and surrounding property,
whether arising out of the negligence or otherwise, pursuant to the Company and/or the
Team and/or the Players' entry into, attendance at and/or participation in the Tournament;

7. acknowledges that any individual whose name does not appear as a "Player" on the
preceding page hereof may not participate in the Tournament on behalf of the Team
and/or the Company and that GRS accepts no liability, and will not be held responsible for
any injury, damage or loss to property whether arising out of the negligence or otherwise,
pursuant to such individual's attendance at and/or purported participation in the
Tournament;

8. agrees that the Company hereby indemnifies and holds GRS harmless from any claim
which the Team and/or any one or more or all of the Players seek to enforce,
notwithstanding 6 above, against any one or more or all of the Relevant Parties pursuant
to the Team and/or the Player's entry into, attendance at and/or participation in the
Tournament.