APPLICATION FOR THE 19TH ANNUAL

DILLSBURG DUAL SHOOTOUT
Soccer Tournament
October 8 & 9, 2011

Team Name
Please Pick Age Group: Based on August 1, 2011 date of birth.			Girls U09 FULL Girls U10 FULL Girls U11 FULL Girls U12 8V8 FULL Girls U12 11V11 FULL Girls U13 FULL Girls U14 FULL Boys U09 FULL Boys U10 FULL Boys U11 FULL Boys U12 8V8 FULL Boys U12 11V11 FULL Boys U13 FULL Boys U14 FULL
Team's record for last season.
If a New Team and you have no record, pick YES. No Yes	Wins	Losses	Ties
Current level of soccer you are playing at in your league. Division 1, 2, or 3/ Division 1 being most competitive.			1 2 3
My team is willing to play in the next higher age group.			No Yes
Soccer Club Affiliation
Soccer League Affiliation	CPYSL BMYS BBSL CCTL CL CMSSL CVGSL CSL DELCO HCSL ICSL IGYSL LANCO LIJSL LVYSL MASL MPSL MSL NCPYSL NCSL NETSL NEYSL OBSL PAGS RBJSL RSL SJGSL SJSL SLSL SPSL UBSL UJSL WAGS WPSL YUSA OTHER
State Soccer Association	EPYSA      Eastern Pennsylvania Youth Soccer Association ENYSSA     Eastern New York Soccer Association DYSA      Delaware Youth Soccer Association MSYSA      Maryland State Youth Soccer Association NJYSA      New Jersey Youth Soccer Association PAWEST     Pennsylvania Western Association USCS      US Club Soccer VYSA       Virginia Youth Soccer Association WVYSA      West Virginia Youth Soccer Association OTHER
Contact Name
Street Address
City
State
Postal Code
Cell Phone Emergency Contact # format: (999)999-9999	() -
E-mail address