Essex United Soccer Club

Date Received________________

17th Annual Tournament & Shootout

Check Number________________

June 21-22, 2008

2nd______  3rd________

Application Form

_____________________

Division:

U10 Girls

U10Boys

U12 Girls

U12Boys

U14 Girls

U14Boys

U16 Girls

U17 Boys

(Circle One)

Team Name:

Coach's Name:

Telephone:

home

Address:

work

E-mail:

Asst./Mgr:

Telephone:

home

Address:

work

E-mail:

Affiliation:

USYSA

FIFA

OTHER

(Circle One)

Competition Level:

Recreational

Club B

Club A

Select

(Circle One)

Team Record in 2007:

W_________  L_______  T _______  League Finish__________

Tournament/Team Achievements:

Entry Fee:

$225 (U10)

$325 (U12)

$375 (U14)

$425 (U16 and U17))

Return completed Application, Preliminary Roster and Payment to Essex United Soccer Club

12 Lang Drive

Essex, VT  05452

TRAVEL PERMITS, PLAYER PASSES and GENERAL RELEASE FORMS ARE REQUIRED FOR ALL PLAYERS AT REGISTRATION!

For tournament information, visit our web site at www.essexunitedsoccer.org

or address questions to EUSCT08@yahoo.com

Cheryl Bowers

Essex United Soccer Tournament

12 Lang Drive

Essex, VT  05452