Team Information:
Age Division Preference: ________ Boys ___X___ Girls (no U15 or U17 girls division)
______U10 ______U11 __X___ U12 _____U13 _____U14 _____U15 ______U16 ______U17 ______U19
(Note: Final placement for teams requesting to play up is not guaranteed. All players must meet the age requirement of the division.)
Birthdate of oldest player: ____8/5/90___________
Competition Level: _____Recreational __X__Club _____Premier
Team Name:___Portage Lightning_________________________ Hometown:____Portage____________________
Jersey Color(s):____White__________ Alternate Jersey Color(s):______Gold________
League:______West Michigan Youth Soccer___ Club Affiliation:______Portage Soccer Club____________
League Registrar:_____Brian Kastman___________ Phone: ( _616_ ) ____226-9471_____________
Address (Street, City, State, Zip):________12345 West Maple Street_____________________________________
____________Portage, MI 49002______________________________________________________
Coach:____Jane Doe_________ Phone: ( _616_ ) ____555-2222______
Address (Street, City, State, Zip):_____67890 Maple West Street______________
________Portage, MI 49002____________________ League Manager:____Sue Doe____________ Phone: ( _616_ ) ____555-1111_____
Address (Street, City, State, Zip):_____34567 West Maple Street__________________
_______Portage, MI 49024_______________________
Send information to: ______Coach __X__Manager
Send housing information? ______ Yes __X___ No
*Fax Number:______(616) 555-3333____________ To Whose Attention?______Sue Doe_________
(*All Canadian teams must provide a Fax number!)
League record for the past three seasons:
2001:_____6-2-0________ 2000:____5-1-2______ 1999:_____4-4-0______
Tournaments entered in 2001 and team record:
__________Portage Invitational Soccer tournament 5-0-0__________________________
________Ann Arbor Invitational 2-1-0__________________________
___________________________________________________________
Has this team played in previous Portage Invitationals? __X___01 __X___00 __X___99 ______98 ______ Prior
Has this coach been to previous Portage Invitationals? __X___01 ______00 ______99 ______98 ______ Prior
Signature:_________________________________ Date:_________________
I,_____Sue Doe___________, the coach/manager of ___Portage Lightning____________ assure that the information given above is accurate and agree on the behalf of the team I represent to abide by all USYSA, MSYSA, and Portage Invitational Soccer Tournament rules and regulations. I understand that there can be no refunds after teams are accepted for participation.