MARSHFIELD INFERNO

MYSA (Marshfield Youth Soccer Association)

www.marshfieldyouthsoccer.org

2009/2010 OUTDOOR LEAGUE Registration

Player Information: Returning Player   Yes  /  No  If yes, 2009 Team ____________ Uniform # ______

Last Name: _______________________________  First Name ____________________________

Address: _____________________________________________________________________________________

City: ______________________ State/Zip _____________________ Phone: ______________________

Date of Birth _____/ _____ / _____    Gender: M / F

Parent Home E-mail: __________________________  2^nd E-mail: _______________________________

PARENT/LEGAL GUARDIAN INFORMATION :

Father’s Name :___________________________   Mother’s Name :______________________________

Address:________________________________  Address:_____________________________________

Phone# (Home/Work/Cell) ___________________ Phone# (Home/Work/Cell)_____________________

            ONSITE REGISTRATION:  End-of-Year Picnic at Wildwood Pavilion July 21, 5pm to 8pm

            MAIL IN OPTION DUE BY: JULY 21, 2009

                                    MYSA (Marshfield Area Youth Soccer) Registration

                                    Registrar

                                    P.O. Box 636

                                    Marshfield, WI 54449

ALL REGISTRATIONS FOR ANY RETURNING PLAYERS RECEIVED AFTER JULY 21 WILL BE SUBJECT TO A $50.00 LATE FEE

Please make registration check payable to Marshfield Youth Soccer Association or MYSA

Check # Enclosed: __________ Amount: $_________ Number of registrations paid with this check: __

__ I would like to be considered for financial assistance. NEW REQUIREMENTS ARE BEING APPLIED TO 2010 SEASON!

FOR MYSA USE ONLY

Checklist: ____ Parent/Guardian Signature Liability and Medical consent

                 ___$60 registration U10 or $100 registration fee U11 and up.

                  ____Headshot photo for player ID card

                          PHOTO MUST BE TAKEN BY MYSA MEMBER at onsite registration

                   PHOTOS THAT ARE MAILED MUST BE NO LARGER THAN 1-1/2”

                         ____Copy of birth certificate, new registrations only

                          ____MYSA volunteer form

                          ____Indoor Soccer Program U10-12 $30

                        ____Indoor Soccer Program U13+ $20