42nd Philadelphia Youth Soccer Classic Application

Team Name: Division: Age:

Team Colors

Shirt: Short: Alt shirt:

Coach:

Home Phone: Cell Phone:

Address:

City: State: Zip:

E-mail Address:

Name of Soccer Club:

Name of Your League:

Name of Your State/Provincial Association:

Name of Insurance Company:

Team History

Most recent League Record Won Lost Tied

Most recent Tournament Record Won Lost Tied

Last Year's State Cup Record Won Lost Tied

Application Deadline has been extended
You will be notified of your acceptance or rejection.

CHECKLIST
___ Application filled out and signed
___ Check enclosed for $350.00 or $425.00 made payable to UJSL
____ One copy of official State or Province roster enclosed
My Team Meets All Requirements Outlined In This Tournament Invitation

Coach Signature: ______________________________________________________________________

Mail to: Pat Hamill 3123 Friendship Street Philadelphia, PA 19149

Print and keep a 2 copies of this form BEFORE clicking on the "SUBMIT" button.