April 7, 2012
Individual Team Application Form
Deadline: March 7, 2012
Name of
Team______________________________________ Age
Group U-______
If U-12
please circle requested team size 8v8 11v11
Level
of Play (circle one): A B
Name of Club
______________________________________ Boys
___ Girls______
League________________________________ State Association________________
Team Colors
Jersey_________________
Shorts_________________ Alternate____________________
Please provide us
with a recent team history:
League
Play
Season/Year League Age Group/Division Standing
Fall 2011
Spring 2011 ____________
Tournament
Play
Season/Year Tournament Age Group/Division Standing
Coach: Manager:
Name ____________________________ Name
_____________________________
Address____________________________ Address_____________________________
_____________________________ _____________________________
Phone (H)___________________________ Phone
(H)___________________________
(W)__________________________
(W)__________________________
e-mail________________________
e-mail________________________
Coach/Manager
Signature: _____________________________ Date: ________________
Mail completed
application and check for $400.00 (U-9 & U-10 teams)
or $425.00 (U-11
thru U-16 teams) payable to
“
c/o Jeff Privett
410-920-8032