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Form MVA 02

By Nicole Knight,2014-12-07 02:56
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Form MVA 02

    FORM MVA 02

    MALTA VOLLEYBALL ASSOCIATION

    COACHES’/ BENCH OFFICIALS’ / MEDICAL REGISTRATION FORM

    SEASON 200 / .

Position: Coach / Bench Official / Medical * (delete as necessary)

    Club: ___________________________________

    Name: __________________________________

    Date of Birth: ______ / ______ /______ Place of Birth: ________________________ Nationality: ______________________ I.D. No.: _________(__) Passport No.:______________ Address: ________________________________________________________________________ Telephone (H):____________ (W):____________ (Mobile):_____________ (Fax):____________ E-Mail Address __________________________________________________________________ * Only those individuals with a qualification in volleyball coaching should be registered as coaches.

For Coaches / Medical Personnel Only

Type of Qualification Full Name of Qualification Issued By Date Issued

    (Cert, Dip, Degree)

    ___________________________ ______ / ______ / ______ Official’s Signature Date

    ___________________________ __________________________ ___________________( ) Club Official’s Name Signature I.D. Card No.

FOR OFFICIAL USE ONLY;

    Received by M.V.A. Secretariat Date: ______ / ______ / ______

Signed _______________________________________ Registration No. ;;;;

    This form must be handed to the MVA Secretariat during the MVA Office opening hours, accompanied by a Lm5.00 fee, copy of qualifications (if necessary), photocopy of the ID Card/Passport and three passport photos.

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