Team Registration

Team Information Club Name:
Team Name:
Team Number:

Affiliation:
CSYSA
ASYSO
Other:

Hotel Information Hotel Name:
City:

Contact Information

Head Coach Information Name:
Home Phone: - -
Cell Phone: - -
E-Mail:
Address:

Alternate Contact Information Name:
Home Phone: - -
Cell Phone: - -
E-Mail:
Address:

Who is to receive tournament information?
Head Coach
Alternate Contact

Tournament Information If requesting to play up, check this box --> And select age division -->

Requested Bracket: Note: Premier level teams must register for gold in their age bracket
First Choice:
Second Choice:

Team Record Fall 2009 Record
Age:
Division:
Premier 1/Division 1
Premier 2/Division 2
Classic/Division 3
Challenge/Division 4
Wins: Losses: Ties: Place:

Spring 2009 Record
Age:
Division:
P1
P2
Classic Blue
Classic Silver
Challenge 1
Challenge 2
Wins: Losses: Ties: Place:

Payment Option 1 (Preferred for faster response) Pay online using a credit card!
Print off this sheet for your own records
Then click "Submit" then go to the PayPal link at the bottom of this form.
You will be able to use your credit card securely on the following page using Paypal .

Check this box to indicate that you understand the "Notice" below
And that you plan to pay using a credit card online.

Payment Option 2 Print off this Completed Registration page and send
Entry Fee of
U10: $375
U11-U14 $550
U15-U18 $575
Check/ MO Only to:

Pueblo Rangers
1644 W US Hwy 50
Pueblo, CO 81008

Then click "Submit"

Check this box to indicate that you understand the "Notice" below
And that you plan to pay by mail.

Notice Registration will not be processed without Form & Payment.
Entry fees are forfeited if a team withdraws after entry deadline. 01/10/2010
The tournament director reserves the right to classify teams.

Pay with PayPal -- Remember to submit registration before proceeding to PayPal