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The PIT Indoor Soccer League 2011 TEAM APPLICATION

TEAM NAME_________________________________________________ SESSION/AGE GROUP (circle) PLAYER ROSTER -

1--U8

1--U10

U8 AND U10 - 10 PLAYER MAX

~

2--U12

2--U14

U12 AND U14 - 6 PLAYER MAX

EACH TEAM MUST HAVE ONE FEMALE ON THE FIELD AT ALL TIMES (ALL FEMALE PERMITTED) 1.

__________________________________________

DOB __________________

2.

__________________________________________

DOB __________________

3.

__________________________________________

DOB __________________

4.

__________________________________________

DOB __________________

5.

__________________________________________

DOB __________________

6.

__________________________________________

DOB __________________

--------------------------------------------------------- U8 & U10 ---------------------------------------------------------7.

__________________________________________

DOB__________________

8.

__________________________________________

DOB__________________

9.

__________________________________________

DOB__________________

10.

__________________________________________

DOB__________________

Proof of age must be provided upon request

COACH (required) ____________________________________________ ADDRESS ______________________________________________________________________ PHONE ____________________

CELL PHONE ______________________ TEXT? (circle)

Y

N

E-MAIL ________________________________ LEAGUE REGISTRATION FEE IS $225/team

Checks made payable to: The PIT Center

$125 Non-refundable deposit due with application – balance due before first game Deliver or mail to:

Sube Insurance Attn: MIKE 614 S Franklin Ave. Somerset, PA 15501

PIT Indoor Soccer League Application 2011