Registration Form

Saturday & Sunday, January 23^rd & 24^th 2010

Age Groups

Male Female

U-8  August 1, 2001—July 31, 2003 U-8 

U-10  August 1, 1999—July 31, 2001 U-10 

U-12  August 1, 1997—July 31, 1999 U-12 

U-14  August 1, 1995—July 31, 1997 U-14 

U-16  August 1, 1993—July 31, 1995 U-16 

U-19  August 1, 1990—July 31, 1993 U-19 

O-20  Must be born prior to August 1, 1990 O-20 

O-30  Must be born prior to August 1, 1980 O-30 

NOTE: No younger players permitted to play in the O-20 & O-30 Groups!

Team Name _____________________________________________________________________

Coach/Contact Name ______________________________________________________________

Address _________________________________________________________________________

City, State & Zip __________________________________________________________________

Fax Number (________) _______________________ Email ______________________________

Home Phone (________) _______________________ Work Phone (____) __________________

Entry Fee—$190.00, please make checks payable to: Hollidaysburg Soccer Association

Please return the completed registration form to:

P.J. Kelly

2707 Spruce Ave

Altoona, PA 16601

Registrations are due no later than January 8^th, 2010

For Credit Card Payment Only

 VISA  MASTERCARD  DISCOVER

Card #:_____________________________________Expiration Date:____/____/____

Print Name:_________________________Signature:___________________________