MATCH DEFERRMENT FORM

COMBINED BATHURST / ORANGE COMPETITION (2006/01)

I, , of

(Club Secretary of Team requesting the deferment) (Name of Club)

Representing,

(Name of Team and Age Group)

WISH TO APPLY FOR THE APPROVAL TO DEFER THE FOLLOWING MATCH:

The reason for our Deferment request is due to:

Original Match Details:

Grade:

Date Scheduled:

Time Scheduled:

Original Venue:

Home Side:

Away Side:

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COMMITTEE USE ONLY BENEATH THIS LINE

Approval BDS By & On

Approval ODSA By & On

New Match Details:

New Date:

New Time:

New Venue:

COPIES TO (Initial Receipt):

ODSA BDS REFEREES HOME SIDE AWAY SIDE

This form must be FULLY COMPLETED at least 7 days PRIOR to the original scheduled match.

Deferring a match may mean that home ground advantage will be lost.

Matches MUST and WILL be rescheduled within the constitutional 6 week allowed period.