Mid-New Jersey Youth Soccer Association

Affiliated Club Registration

Fall 2002 Season

Please type or print legibly all information.

Full Club Name:

Shirt Color: |Short Color:

FEES

MNJYSA Team Registration: ____ teams at $100.00 . . . . .$________

NJYS Team Registration Packets, Div. I-IV ____ teams at $ 95.00 . . . . ...$________

NJYS Team Registration Packets, Small-sided ____ teams at $ 60.00 . . . . ...$________

Extra Player Passes ____ teams at $ 6.00 . . . . ….$________

Extra Coaches Passes ____ teams at $ 6.00 . . . ….. $________

Fines: ___________________________________________________ . . . . $________

(Explanation)

(Make checks payable to MNJYSA ) Total. . . . …………..$________

FIELDS WHERE HOME GAMES ARE SCHEDULED TO BE PLAYED

1. ________________________________ 5. _______________________________

2. ________________________________ 6. _______________________________

3. ________________________________ 7. _______________________________

4. ________________________________ 8. _______________________________

CLUB OFFICERS

League Contact: ______________________________ Phone: (____) ______________

Mailing Address: ______________________ City: ________________ Zip: _________

Email Address:_________________________________________

President: ___________________________________ Phone: (____) ______________

Mailing Address: ______________________ City: ________________ Zip: _________

Email Address:_________________________________________

Club Web Manager: ___________________________ Phone: (____) ______________

Mailing Address: ______________________ City: ________________ Zip: _________

E-Mail Address: ____________________________________

(Signed) Date:

REFEREES: (One for every three teams registered, Minimum of one; See Handbook Section 3.3 for requirements)

Name: _____________________________________ Phone: (____) _______________

Address: ____________________________ City: ________________ Zip: _________

Email:__________________________________________

Full time _________ Weekdays __________

Part time _________ Saturdays __________

Sundays __________

Radius willing to travel for a match:

5 miles __________ 5-10 miles __________ 10 miles __________

---------------------------------------------------------------------------------------------------------------------

Name: _____________________________________ Phone: (____) _______________

Address: ____________________________ City: ________________ Zip: _________

Email:__________________________________________

Full time _________ Weekdays __________

Part time _________ Saturdays __________

Sundays __________

Radius willing to travel for a match:

5 miles __________ 5-10 miles __________ 10 miles __________

---------------------------------------------------------------------------------------------------------------------

Name: _____________________________________ Phone: (____) _______________

Address: ____________________________ City: ________________ Zip: _________

Email:__________________________________________

Full time _________ Weekdays __________

Part time _________ Saturdays __________

Sundays __________

Radius willing to travel for a match:

5 miles __________ 5-10 miles __________ 10 miles __________

---------------------------------------------------------------------------------------------------------------------

Name: _____________________________________ Phone: (____) _______________

Address: ____________________________ City: ________________ Zip: _________

Email:__________________________________________

Full time _________ Weekdays __________

Part time _________ Saturdays __________

Sundays __________

Radius willing to travel for a match:

5 miles __________ 5-10 miles __________ 10 miles __________