2024 INTERCITY P1/P2 Dispensation request form

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It is required under the Intercity Competition Regulations that the secretary of your club must complete the below from.

Email *

Club: *

Please select which grade you are applying dispensation for:

Premier 1

Premier 2

Clear selection

Please state the Competition Regulation you wish to request a dispensation for? *

e.g. Player eligibility 4.6

Players name: *

Players registered grade: *

Playing Position: *

Field Player

Goal Keeper

Date for dispensation: *

Reason for dispensation *

Please add as much information as you can here

e.g. what other measures you have taken to avoid this request, why this player was chosen, suitability to the grade they will fill in for, other impacting reasons for this request

Has the secretary for your club completed the form? *

By ticking "Yes" you have agreed that the Secretary has completed this form

Yes

Secretary name: *

By typing the Secretary name below you agree that the Secretary has completed this form

Send me a copy of my responses.

Submit

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