2010 AMDT Application
($500)
Name of Team: __________________________________________________________________
Clarification of level of play (check each appropriate circle):
O Town / Club / Classic
O Tournament Team
O Qualifying Premier Team
O Division ____
O League
O Name of Cup Tournament (please name):
______________________________________
O Final place in Tournament (please name):
________________________________________
Team Information:
Home Jersey: __________________
Away Jersey: __________________
Age of Team: U-____ Boys / Girls (Please circle one):
# of Players on Roster: ______________ Last Season's Record: ______________
Special Team Accomplishments (Including Tournaments):
______________________________________________________________________
Contact Names (circle preferred contact):
Coach: ______________________________________________________________________
Manager: ______________________________________________________________________
Preferred Contact’s Address (required): ________________________________________________
Contact Information (required):
Coach
Home Telephone: _________________________________________________________________
Work: ___________________________________________________________________________
Cell: ______________________________________________________________________
Email: ______________________________________________________________________
Manager
Home Telephone: ___________________________________________________________________
Work: _____________________________________________________________________________
Cell: ______________________________________________________________________
Email: ______________________________________________________________________
Additional Comments: ______________________________________________________________
If you would like email notice of acceptance please enter an email address:
Email:_________________________________________________________________
Signature - Coach / Manager (required):
______________________________________________________________________