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FFA Coach Education – Advanced Pathway
FFA/AFC CENTRAL ‘B’ LICENCE APPLICATION
COURSE DETAILS
Course Name:
Start Date:
End Date:
Location:
Course Information:
FFA/AFC ‘B’ Licence
22nd October, 2014
2nd November, 2014
Australian Institute of Sport.
Leverrier St, BRUCE.
ACT, 2617
The FFA/AFC ‘B’ Licence is targeted towards Top Amateur Senior Team Coaches and Elite
Youth Team Coaches, as well as State Team Coaches. Accepted candidates will need to hold
an FFA/AFC ‘C’ Licence, or a recognised overseas ‘C’ Licence.
Applications for ALL Advanced Coaching Courses close one month prior to the
course commencement date.
CANDIDATE DETAILS
Please ensure you update all your details on the MyFootballClub website (below) before completing this form:
http://www.myfootballclub.com.au/index.php?id=46.
FFA Number:
Given Name:
Middle Name:
Surname:
D.O.B:
Gender:
Street Address 1:
Street Address 2:
City:
State:
Post Code:
Country:
Email Address:
Mobile Number:
Nike Apparel Sizes:
Home Phone:
(S/M/L/XL/XXL)
Tracksuit:
Polo Shirt:
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Training Strip:
Socks:
FFA Coach Education – Advanced Pathway
FFA/AFC CENTRAL ‘B’ LICENCE APPLICATION
AFC OFFICIAL DOCUMENTATION
The Asian Football Confederation (AFC) requests all Member Associations collect the following official documentation for
registration on the AFC Coach Education database(s): (please tick once attached)
* NOTE – applications that do not provide the below documentation will be returned.
 Coloured Passport Photo
 Coloured Copy of Passport (if unavailable, see below)
 Copy of Birth Certificate
COURSE ENTRY REQUIREMENTS
In order to be eligible for the FFA/AFC ‘B’ Licence, all accepted candidates will need to hold an FFA/AFC ‘C’ Licence, or a
recognised overseas ‘C’ Licence, and be a minimum of 18 years of age. (please tick once attached)
 I have an FFA/AFC ‘C’ Licence
 I have an overseas ‘C’ Licence, currently recognised by the FFA
 I have an overseas ‘C’ Licence, not currently recognised by the FFA*
* If you fall into section number 3 above, please contact technical@footballaustralia.com.au for information on how you can
apply for Recognition of Overseas Coaching Qualification (RoOCQ) through Form 9. Please submit both applications together
for efficiency in the registration process.
COURSE FEE & PAYMENT
Please fill out all details below relating to the course fee and other associated costs. A candidate will not be accepted onto the
course until full payment is received. FFA does not accept part payments or payment plans.
N.B - Only Hyundai A-League Clubs and State Member Federations can request an invoice to pay on.
 OPTION 1
Accommodation Required
 OPTION 2
No Accommodation Required
Course Fee:
GST:
Total Cost:
$ 3,500.00
$ 350.00
$ 3,850.00
Course Fee:
GST:
Total Cost:
$ 2,200.00
$ 220.00
$ 2,420.00
Total cost includes course tuition, course workbook(s),
NIKE apparel, 3 daily meals, and accommodation.
Total cost includes course tuition, course workbook(s), NIKE
apparel and lunch daily.
Payment Method:
 Credit Card: (N.B - we do not accept AMEX)
 Cheque / Money Order: (please attach to this form)
Card Type:
Card Number:
Expiry Date:
Signature:
Please make the cheque payable to:
‘Football Federation Australia’
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FFA Coach Education – Advanced Pathway
FFA/AFC CENTRAL ‘B’ LICENCE APPLICATION
APPLICANT AGREEMENT & SIGNATURE
By signing below, the applicant warrants that the information provided above is true and correct, and fully agrees to
comply with the FFA Advanced Coaching Course Terms and Conditions (as set out below), and it’s incorporated
documents, including the FFA statutes.
Signature:
Date:
Terms and Conditions - FFA Advanced Coaching Course
By registering with Football Federation Australia Limited (ACN 106 478 068) ( FFA) using the FFA registration system, you acknowledge and agree to the following terms and conditions.
1.
2.
If you would like to participate in the Course, you must:
(a)
complete all areas of the registration applications (Application); and
(b)
pay FFA the course fees either by credit card, cheque or money order made payable to “Football Federation Australia Limited”.
You acknowledge that FFA will not process an Application that does not comply with clause 1 (including if a credit card cannot be charged for the designated amount) or which is incorrect,
incomplete, unclear or damaged. If you are successful in your application, FFA will notify you in writing using the nominated details from your Application.
3.
You acknowledge that if you cancel your place in the Course less than four (4) weeks before the start date, you are entitled to a refund, but FFA reserve the right to retain any costs
incurred on their behalf based off your intended attendance.
4.
You agree to comply with FFA Statutes, including the National Registration Regulations, National Code of Conduct, National Disciplinary Regulations and Grievance Resolution Regulations,
copies of which are available on www.footballaustralia.com.au or on request;
5.
You acknowledge and agree that there are inherent risks associated with participating in the Course and football activities that may result in personal injury and you agree to fully bear
those risks.
6.
You acknowledge that if you suffer any injury (including death) whilst participating in the Course and football activities and a cause of injury was the negligence, assault or breach of other
obligations imposed by laws, then the liability of FFA (including its directors, officers, employees, agents, contractors and assigns) is limited to the extent of any applicable insurance policy
held by FFA and the amount which such insurer pays under the policy or applicable statutory insurance scheme;
7.
You agree not to bring any claim or proceeding against FFA (including its directors, officers, employees, agents, contractors and assigns) at any time for any damage, loss, injury or liability
that you may suffer or incur in connection with or arising out of your participation in the Course and football activities. Except for liability that by law cannot be excluded, FFA excludes all
liability to you in tort (including negligence), contract or otherwise for acts or omissions of FFA (including each of their directors, officers, employees, agents, contractors and assigns).
8.
Nothing in clause 5 affects your rights under the Competition and Consumer Act (Cth) or similar legislation under which FFA’s liability may not b e excluded. If FFA is liable to you for any:
(a)
breach by FFA of any express term of this Agreement or any term implied under the general law; or
(b)
any tort committed by FFA (including negligence but not including fraud),
FFA’s liability to you is limited (at FFA’s election) to FFA repaying any amounts paid by you under this Agreement or supplying or resupplying any Course services to which you are entitled
in accordance with the terms of this Agreement.
9.
You agree to indemnify FFA (including its directors, officers, employees, agents, contractors and assigns) from and against all actions, proceedings, suits, claims, liabilities, damage, costs
and expenses that may be incurred or sustained by FFA arising out of any person commencing any proceedings against you for any assault, negligence and/or breach of the FFA Statutes
or Laws of the Game.
10.
You acknowledge that the personal information that FFA collects from you is used and disclosed for the purposes set out in our Privacy Policy, including processing your registration, the
organisation, conduct and promotion of Competitions and Matches, the provision of football-related information and offers from FFA, and information about our commercial partners,
tickets and events as part of the FFA Football Family. You further acknowledge that FFA may use third parties to collect your personal information or give them your information to help us
run football or as required by law (such as IT providers, venue operators or ticketing operators). A copy of the Privacy Policy is available on www.footballaustralia.com.au. You may
request access to your personal information that FFA holds by sending an email to privacy@footballaustralia.com.au;
11.
You consent to the collection, use and disclosure of your personal information as described in clause 12. If you do not want to receive certain information from FFA and its commercial
partners, you will be given an opportunity to opt out of such communications.
12.
You grant FFA a non-exclusive, royalty free, world-wide, irrevocable license to use your name and/or image in any form or media format for the purpose of marketing and promotional
activities.
13.
You acknowledge and agree that FFA may:
(a)
reject or choose not to accept an Application in its absolute discretion, including non-compliance with eligibility requirements, not enough numbers to stage the Course or
too many applications for the Course;
14.
(b)
not award accreditation in situation that it deems fair, such as, but not limited to you not attending all modules of the Course;
(c)
choose not to enforce a term of this Agreement in some cases in its absolute discretion without affecting its right to enforce that term in other cases; and
(d)
change all dates, session times, durations and locations of the Course without notice to you.
You agree:
(a)
with FFA's interpretation that a determination made by an FFA employee that you were successful or unsuccessful in passing th e Course does not constitute a Grievance for
the purposes of the FFA Statutes;
(b)
to otherwise submit exclusively to the jurisdiction of the Grievance Resolution Regulations and not to attempt to resolve any dispute the subject matter of the FFA Statutes
in a court of law.
15.
You acknowledge that FFA may de-register you at any time by written notice, including if you do not comply with these Terms and Conditions or its incorporated documents.
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FFA Coach Education – Advanced Pathway
FFA/AFC CENTRAL ‘B’ LICENCE APPLICATION
RETURNING THIS FORM
Your enrolment on this course will not be accepted unless the application is filled out properly, with official documents attached
and until full payment is received.
Please send your application form and with all documentation included via post to the following address:
FFA ADVANCED COACHING COURSES
Locked Bag A4071
Sydney South
NSW, 1235
We thank you for your continued interest in FFA Advanced Coaching Courses. You will be contacted directly via email to
confirm your place on the course and will receive any related documentation/tasks shortly after.
If you have any questions relating to your application or Advanced Coaching Courses,
please visit
http://www.footballaustralia.com.au/getinvolved/coaching/advancedcourses
or contact: technical@footballaustralia.com.au
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