State or Territory (STA) Pennant Declaration

A player wishing to register with a new Club only for the purpose of playing Pennant in a State or Territory Association (STA) different from the STA which they are currently affiliated with should complete this form and apply to the STA the player is currently affiliated with.

This form declares that a player is not under an order of suspension or expulsion and has not resigned their membership because of disciplinary proceedings.

NOTE: THIS FORM IS NOT A STATE OR TERRITORY (STA) CLEARANCE FORM Players wishing to change their nominated club for the purposes of playing Championship Events in a different STA must submit a State or Territory (STA) Clearance application.

PLEASE SEND THIS COMPLETED FORM TO YOUR CURRENT STATE OR TERRITORY ASSOCIATION (STA)

DETAILS OF PLAYER Surname

Given Name(s) STA ID #

Name of Nominated Club

Name of Club you will be representing

DECLARATION BY CLUB AND STA TRANSFERRING FROM:I certify that the details above are, to the best of my knowledge, correct. The above mentioned member has fulfilled all of their financial obligations to the Club, is not under an order of suspension or expulsion and has not resigned their membership because of disciplinary proceedings.

____________________________________Signed – Secretary Club Transferring From

_______________________Print Name

____________Date

____________________________________Signed - Player

_______________________Print Name

____________Date

STATE/TERRITORY USE ONLYThe member listed above is: APPROVED / NOT APPROVED (circle one)

STA TO SCAN AND EMAIL APPROVED FORM TO STA OFFICE THE PLAYER IS SEEKING REGISTRATION WITH.

____________________________________Signed - STA

_______________________Print Name

____________Date

STA

STA