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1. Player Identity

Player First Name *

Player Last Name *

Date of Birth (MM/DD/YYYY) *

Gender *

MaleFemale

2. Location & Experience

Location preference *

City of Residence *

Current Club / Organization

3. Player Position & Level *

Position (multi-select) *

GKDEFMIDFWD

Desired Level of Play *

4. Adult Contact & Consent

Adult Contact Name *

Adult Contact Email *

Adult Contact Cell *

I consent to be contacted about this registration and future communications.

5. 2nd Adult Contact (Optional)

Adult Contact Name

Adult Contact Email

Adult Contact Cell

6. Notes (Optional)

Notes

Application Details