UNITED STATES FUTSAL
NATIONAL CHAMPIONSHIP XIII APPLICATION

Alameda Point Gymnasium, Alameda, California - July 24 - 26, 1998.

NAME OF STATE / NATIONAL ASSOCIATION: ____________________________________________________

NAME OF TEAM:_____________________________________________________________________________

AGE CATEGORY:_____________________________________________________________________________

NAME OF COACH/MANAGER:__________________________________________________________________

ADDRESS & PHONE #: _______________________________________________________________________

PLAYERS NAME

DOB

JERSEY #

REGISTRATION #

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I hereby certify that the above information is true and correct, and that I have read and understand the rules.

Manager Signature:____________________________________________ Date:____________

PLAYERS NAME	DOB	JERSEY #	REGISTRATION #
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