One form per team Date: _____________________________
Club/Team____________________________________
Team Contact:_________________________________
Team Coach: _______________________________
Cell Phone__________________________________
Coach’s Cell Ph________________________________
Email______________________________________
Coach’s Email: ________________________________
1) Does the coach have multiple teams participating? ___Y ___N If yes, which team(s)__________________ All Special request will be considered but due to field and time limitations may not be honored _________________________________________________________________________________________ My team is affiliated with: _____ FYSA ______ US Club
______Both
_______ We would like this to be State Cup Qualifying Match
Please check off the dates of participation. DAY DATE AGE
SITE
REGISTRATION DEADLINE
Academy ____Saturday ____Saturday Saturday ____Saturday
Thomasville, Ga Tallahassee Dothan, AL Tallahassee
Aug. 20th Sept. 3rd Sept 24th Oct. 1st
Tallahassee Navarre, FL Tallahassee
July 30th Aug. 27th Oct. 1st
September 8th September 22nd October 13th October 20th
Ages U9-U12 Ages U9-U12 Ages U9-U12 Ages U9-U12
**
Play date only
**The play date in Dothan, AL is scheduled and registered by Enterprise Futbol Club.
Premiere ____Saturday August 18th ____Saturday September 15th ____Saturday October 20th
Ages U13-U18 Ages U13-U18 Ages U13-U14(Only)
Club Registration (indicate teams participation by age group and gender) ____U10 ____Boy _____Girl
_____U13 ____Boy _____Girl
_____U16____Boy _____Girl
____U11 ____Boy _____Girl
_____U14 ____Boy _____Girl
_____U17____Boy _____Girl
____U12 ____Boy _____Girl
_____U15 ____Boy _____Girl
_____ U18____Boy _____Girl
Fee(s): 1- date: $150/ 2- dates: $275/ 3-dates: $400 Please return along with your entry fee to: Warner Soccer /WASL/1695-4 Metropolitan Circle/Tallahassee, FL 32308 (850) 386-3866 Fax (850) 386-5799 OFFICE ONLY Received: __________ Notes: