UJSL Columbus Cup 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

Still Accepting Applications

CHECKLIST
___ Application filled out and signed
___ Check enclosed for $375.00 or $450.00 made payable to UJSL
____ One copy of official State or Province roster enclosed
My Team Meets All Requirements Outlined In This Tournament Invitation
$50 Discount for 5 or more teams from same Club

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.