S.L. 626.1 Art. 18OFFICIALS Name and Identity Card Residential Telephone E-mail: Secretary Name and Identity Card Residential Telephone E-mail: Treasurer Name and Identity Card Residential Telephone E-mail: Name and Identity Card Residential Telephone E-mail: Name and Identity Card Residential Telephone E-mail: Name

Valid sport facility licence issued by the Authority: Yes/No (mark as Annex R) AND COMMITTEE MEMBERS OF THE ORGANISATION:

President/Chairperson

Surname:

Number:

Address:

Number:

Surname:

Number:

Address:

Number:

Surname:

Number:

Address:

Number:

Public Relations Officer

Name and Surname:

Identity Card Number:

Residential Address:

Telephone Number:

E-mail:

Integrity Officer

Name and Surname:

Identity Card Number:

Residential Address:

Telephone Number:

E-mail:

Other Members:

Name and Surname:

Identity Card Number:

Residential Address:

Telephone Number:

E-mail: Surname:

Number:

Address:

Number:

Surname:

Number:

Address:

Number:

Surname:

Number:

Address:

Number:

Name and Surname:

Identity Card Number:

Residential Address:

Telephone Number:

E-mail:

Name and Surname:

Identity Card Number:

Residential Address:

Telephone Number:

E-mail:

If there are other committee members, list and give details on a separate INDIVIDUALS IN WHOM THE REPRESENTATION OF THE ORGANISATION

Surname:

Number:

Address:

Number:

Surname:

Number:

Address:

Number:

Surname:

Number:

Address:

Number:

other members in whom representation is vested, list and give details on a separate

DETAILS ABOUT THE OFFICIAL PREMISES: