Winter
Session 1: Indoor
8 games Starts November 1
FORMAT: K-8th grade
5V5 Including Goalies
Recommended
12 Player Roster Games
played Saturday or Sunday
Cost: $450 (8 games) $550 (10 games) tax included. $100 Deposit due with application.
$50 non refundable upon cancellation.
TONY
GLAVIN SOCCER COMPLEX, LLC.
P.O.
BOX 17
COTTLEVILLE,
MO 63338-0017
(636)
939-5151 (636) 939-4117 (fax)
E-mail [email protected]
COMPLETED ROSTER AND BALANCE OF PAYMENT MUST BE SUBMITTED PRIOR TO START OF FIRST GAME
TEAM NAME ___________________________ JERSEY COLOR __________ ALTERNATE_________
MANAGER _______________________________ COACH ____________________________________
ADDRESS ________________________________ ____________________________________
CITY/STATE/ZIP __________________________ ____________________________________
PHONE (H) ________________ (W) _______________ (H) ________________(W) ________________
CONTACT PERSON ________________________ FAX _______________________________
AGE GROUP ____________ GRADE _______ BOYS GIRLS Competitive Recreational
Credit Card Master Card/Visa Card Number_______________________________Exp. Date:___________
Name of Cardholder:____________________________Signature_________________________________
Please circle
Sessions(s) 1 2
3
APPLICATION
WILL NOT BE ACCEPTED WITHOUT CREDIT CARD OR CHECK ENCLOSED
FOR
OFFICE USE ONLY:
Date Received ____________ Amount
Paid __________ Check no _______ Amount Due _________
Date Balanced Paid _________