AYSO Region 9 Adult League Application - Winter 2014

Please make sure that ALL information in the Add/Edit Player Data window is complete and accurate.
1) Print, Sign and Date a copy of this page (some browsers allow you to select Print Preview, Shrink to Fit) after you have clicked on Add or Submit.
2) Print, Sign and Date a copy of the Fair Play Pledge for EACH player.
3) Make payment of $60 for a Player from the Fall 2013 season, $85 for all other Players by check (payable to "AYSO Region 9 Adult League") or by credit card (include Proof of Payment)
4) If any player is new to the Region 9 Adult League then included Proof of Age (copy of Drivers License, Birth Certificate, etc.)
Mail all appropriate items above to:
Mary Hobert; 41 Canfield Court; Thousand Oaks CA  91360; attn: Adult League
Questions?  Need more information?  Contact Mary Hobert

Have you played in Region 9's Adult League in the past?
Enter your Last Name & Date of Birth then click the <Search> button
If your name does not come up, skip down to the Add/Edit Player Data window
Last Name Date of Birth (must be in the format mm/dd/yyyy)  

Is This You?
If yes, click on the PlayerID to display your information in the Add/Edit Player Data window
If no,  skip to the Add/Edit Player Data window
Total Records: 0
Player ID First Name Last Name Dateof Birth Gender City Home Phone EMail Primary
No records

Add/Edit Player Data
Complete ALL information in the form below, then click on the <Add> or <Submit> button below
Scroll back down to this window to make sure that there are no Error Messages in red
Fields marked with a red star * are required information
First Name*    Last Name*  
Dateof Birth* (mm/dd/yyyy)     Gender*
Street Address*    City*    Zip*
Phone Numbers (nnn-nnn-nnnn):  Home*    Cell    Work
E-Mail:  Primary*    Alternate
Medical Insurance Carrier*
Emergency Contact:  Full Name    Phone (nnn-nnn-nnnn) 
Season for which you are applying to play in*   
In addition to playing would you like to:  Coach    Referee    Help Administratively
You may give us the Full Name of one (1) player you would like to have on your team:
We will do all we can to honor player requests for teammates, but we cannot guarantee that all requests can be honored.
Drivers License Number*
 Please help us out by rating your soccer skills on a scale of 1 (never played before) to 10 (semi-pro):* 
 Briefly describe your soccer experience. Also let us know what position(s) you play (e.g. anywhere; prefer midfield; keeper only; what's a position?) *

Your rating and description will be very helpful to us in balancing our teams so that all will have an enjoyable experience.

The Fee for the Winter 2014 Adult League season is $60 for Players from the Fall 2013 season;
$85 for all other Players

Today's Date* (mm/dd/yyyy)     Payment Method*    Check #    Payment Amount
Click Here  if you would like to pay via Credit Card (there is a $2 or $3 additional charge to cover Region 9's PayPal fee)

Enter all requested information above then click here -->  
Scroll back down to this window to make sure that there are no Error Messages in red 


Your signature:  ________________________________________   Date Signed:  ___/___/______