NY/PA Corporate Cup Soccer Showcase Tryout Registration

Please note, there is a $35.00 Tryout Registration Fee collected through PayPal. Once this form is completed and submitted you will be forwarded to PayPal to complete the registration process. Please ensure the Parent/Guardian Name and email address on this form match the information passed to PayPal. Thank You!

Students Name*

First

Last

Parent / Guardians Name: *

First

Last

Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Phone*

Email*

Select Students School*

Students Current Grade:*

Date of Birth*

day

month

year

Shirt Size:*

Try Out Registration is $35.00*

Additional Comments / Information:

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