Fort Smith Express 2016-2017 competitive season U11-U14
FORT SMITH EXPRESS 2016-2017 COMPETITIVE SEASON U11-U14 (BIRTH YEARS 2003-2006) Player Name: _______________________________
These questions help us apply and receive Grants for additional Club Funding:
Contact Cell Phone: ___________________________
_____ Number living in household Household Income (Check one):
Email: ______________________________________
Player Birth Year:__________________
School Currently Attending: ______________________
Payment Method:
___ 0-15000 ___ 15001-20000 ___ 20001-30000 ___ 30001-40000 ___ 40001-50000 ___ 50001-60000 ___ 60001-70000 ___ 70001-80000 ___ 80001-90000 ___ 90001 and up
_______ Mandatory $55 Tryout Fee (refundable if player does not make the team). Players will NOT be allowed to tryout without the $55 tryout fee paid. And select one: _______ Pay in Full for Year $495 (cash, check, credit card) _______ Pay in Full 6 months $247.50 now, $247.50 charged January 10th. _______ I am acquiring a Banner Sponsor to pay my dues. Banner money MUST be turned in by August 1 st and/or January 10th. Player must still pay the $55 tryout fee. _______ Monthly Cash/Check/Credit Card $55.00 a month July-March. (Please note, payment is due on the 1st of each month. If a payment is more than 10 days late, the player will be removed from the team’s roster until payment is made. This means that the player will NOT be allowed to participate in events until current. Cash/Check Payments can be made at 3017 S 70th St Suite A, Fort Smith, AR 72903 (President’s Office) Credit Card Auto Pay: Card Number: _____________________________________________ Expiration Date: ________________________ CV# _______________ Card Mailing Address: ________________________________________ ______________________________________________
Uniforms must be purchased by each NEW player and can be worn multiple seasons. Cost is approximately $100.
I, _________________________ the parent of __________________________ understand the above terms and conditions regarding payment due to Fort Smith Express. I acknowledge that if I am behind on payment, my player will be unable to participate. Signature: ______________________________________________ Date: _____________________
Payment terms are mandatory. No exceptions. Thank you, Fort Smith Express
These questions help us apply and receive Grants for additional Club Funding:
Contact Cell Phone: ___________________________
_____ Number living in household Household Income (Check one):
Email: ______________________________________
Player Birth Year:__________________
School Currently Attending: ______________________
Payment Method:
___ 0-15000 ___ 15001-20000 ___ 20001-30000 ___ 30001-40000 ___ 40001-50000 ___ 50001-60000 ___ 60001-70000 ___ 70001-80000 ___ 80001-90000 ___ 90001 and up
_______ Mandatory $55 Tryout Fee (refundable if player does not make the team). Players will NOT be allowed to tryout without the $55 tryout fee paid. And select one: _______ Pay in Full for Year $495 (cash, check, credit card) _______ Pay in Full 6 months $247.50 now, $247.50 charged January 10th. _______ I am acquiring a Banner Sponsor to pay my dues. Banner money MUST be turned in by August 1 st and/or January 10th. Player must still pay the $55 tryout fee. _______ Monthly Cash/Check/Credit Card $55.00 a month July-March. (Please note, payment is due on the 1st of each month. If a payment is more than 10 days late, the player will be removed from the team’s roster until payment is made. This means that the player will NOT be allowed to participate in events until current. Cash/Check Payments can be made at 3017 S 70th St Suite A, Fort Smith, AR 72903 (President’s Office) Credit Card Auto Pay: Card Number: _____________________________________________ Expiration Date: ________________________ CV# _______________ Card Mailing Address: ________________________________________ ______________________________________________
Uniforms must be purchased by each NEW player and can be worn multiple seasons. Cost is approximately $100.
I, _________________________ the parent of __________________________ understand the above terms and conditions regarding payment due to Fort Smith Express. I acknowledge that if I am behind on payment, my player will be unable to participate. Signature: ______________________________________________ Date: _____________________
Payment terms are mandatory. No exceptions. Thank you, Fort Smith Express
