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CLASH OF THE CLEATS APPLICATION
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Team: Club:
Coaches Name: Email:
Address:
City: State: Zip Code:
Phone (H): (W) (fax)

Age Division:

U10 [  ]
U15 [  ]

 U11 [  ]
U16 [  ]		 U12 [  ]
U17 [  ]		 U13 [  ]
U18 [  ]		 U14 [  ]
U19 [  ]

Male [  ]

 Female  [  ] Club  [  ] Select  [  ] Tournament [  ] Premier  [  ]
State Association: League:
League Record:     W                   L                  T Spring  [  ] Fall  [  ]
Past Tournaments:
Name: Record: Place:
Name: Record: Place:
Jersey Color: (primary) (second)
Requests: (Our attempt to try and help you, we cannot guarantee requested game times):
[    ]  No Friday games [    ]  Late Saturday start (after 10 a.m.)
[    ]  No night games [    ]  Saturday morning check-in
[    ]  Other

All teams and players are required to have their own insurance. In the event of an accident or injury while in transit to, transit from, or participating in the Clash of the Cleats soccer tournament, then Mifflin County Soccer Club and all associated with the tournament shall not be held liable. My team meets all requirements mentioned.
Coach: Date:

Mail Application & entry fee to:
Clash of the Cleats          P.O. Box 1147          Lewistown, PA.  17044