OYSAN 2014 State Cup Team Registration Form
Part of the USYS National Championship Series

TEAM INFORMATION:
Team Name:
Club Name:
League:
Team Age Group/Gender:
Jersey Color:
Alternate Jersey Color:
Coach's First and Last Name Name:

Coach's Phone: (format 555-555-1212)
Coach's Email Address:
Coach's License:
If "Other" Please indicate
Number of Years Team Has Played in State Cup:
Last Year's Result in State Cup:
Wins:
Ties:
Losses:
PRIMARY TEAM CONTACT INFORMATION:
This person will serve as the primary contact for all future communications. Please be sure to enter CORRECT information.
Team Contact First and Last Name Name:
Role with Team:
Team Contact Street Address:
City:
State / Zip:
/
Team Contact Email Address:
Confirm Team Contact Email Address:
Home Phone: (format 555-555-1212)
Mobile Phone: (format 555-555-1212)
Would you like to receieve Text Message alerts?
Yes No
If yes, select your Mobile Phone Provider:
TEAM PERFORMANCE HISTORY:
Although not required, the information requested below helps the commitee in the selection and seeding process.
Fall 2013 League:
Division:
Wins:
Ties:
Losses:
Spring 2013 League:
Division:
Wins:
Ties:
Losses:
Additional Comments:
- List any info which will assist the selection commitee in a proper evaluation. (Max of 250 Characters)
TERMS AND AGREEMENTS:
Agreement:
I am entering the team named in this application the full understanding that all games in this competition will be governed by the following rules and in the following priority: (1) the OYSAN Directives, Rules and Regulations of the Competition as midified from time to time by OYSAN State Cup Chairperson, State Cup Chair Designees or State Cup Commitee, with or without notice, (2) the Rules, Regulations and the constituion of OYSAN, (3) the rules as determined by US Youth Soccer, and (4) the FIFA Laws of the Games. I, further understand, that the $575.00 team application fee is non-refundable. I understand that the rules/provisions of the OYSAN State Cup Tournament are subject to change with or without notice.

I also understand that any and all OYSAN State Cup materials (e.g., schedules, maps, standings, etc) will not be sent via US Mail. All pertinent OYSAN State Cup materials and information will be emailed to each team coach or team contact and all OYSAN State Cup materials and information will be posted on the OYSAN State Cup website at www.oysan.org.
Accurate Agreement:
I CERTIFY THIS APPLICATION IS ACCURATE AND COMPLETE.
PAYMENT INFORMATION:
Payment Method:
Check
Credit Card
Type of Credit Card:
Name on Credit Card: (format Jim Smith)
Credit Card Number: (format: 12345678911234)
Cardholder Street Address:
Cardholder Zip:
Credit Card Expiration Date:
Month: Year: