Cecil Fall Blast Soccer Tournament
November 19, 2011
Individual Team Application Form
Deadline: October 19, 2011
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 2010
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
8v8) or $425.00 (U-11
through U-14 teams) payable to
"Cecil Fall Blast" before the October 19, 2011 deadline to:
Cecil Fall Blast
c/o Jeff Privett
18 Nahide Drive
Elkton, Maryland 21921
410-920-8032