REGION 677 REF REGION 677 REFUND REQUEST

REGION 677 REFUND REQUEST Player Name: Date of Birth: Was player placed on a team?

Yes___

No___ No___

Unknown___

What is the Coach's name: Parent's Name:

City/State/Zip

Street Address:

Cell Phone#:

Day Phone#:

Registration paid by: Cash

Check

Amount

Date

Reason for requesting refund:

Parent's Signature:

Date:

AYSO Region 677 Refund Policy. $35 is non refundable. st is received prior to June 30. A full refund (except for non refundable $35) is available until June 30th A 50% refund of the amount after the non refundable $35, isAugust available from July 1st until July 31st t is received 1 There is no refund available after and including August 1st. You can either fill this form out electronically and email it to [email protected] Or you can print it, fill it in and mail it to: AYSO Region 677 P.O. Box 2943 Canyon Country, CA 91386

FOR AYSO REGION 677 USE ONLY:: Confirmed by Regional Commissioner ____________ Date: Date: ______________ Confirmed by Registrar ______________ Date: ______________ Refunded issued by Treasurer ________________ Date:____________________