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ENROLLMENT FORM
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| * required fields |
| Name: |
* |
| Address #1: |
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| Address #2: |
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| City: |
* |
| State: |
* |
| Zip: |
* |
| Phone: |
* |
| Alt Phone: |
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| Email: |
* |
| Fax: |
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| Date of Birth: |
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| Age: |
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| Sex: |
Male
Female |
| Height: |
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| Weight: |
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| Position: |
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| T-Shirt Size: |
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| Parent/Guardian: |
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| School/College: |
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| Address: |
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| Coach: |
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| Team: |
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| High School: |
District
State
Regional
National
Club - Name:
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| College: |
Division I
Division II
Division III |
Please enroll me in the: |
| Individual Players Program |
One month (Romania & Portugal), 6/23-7/21/10
3 weeks (Romania), 6/23-7/13/10
3 weeks (Spain & Portugal), 7/12-7/29/10
10 days (Spain), 7/12-7/21/10
10 days (Portugal), 7/20-7/29/10
5 weeks (Romania, Spain and Portugal), 6/23-7/29/10
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| Jr. HS, HS, College & Club Team Program |
10 days (Spain) 3/16-3/25/10
10 days (Portugal) 3/16-3/25/10
10 days (Romania) 7/4-7/13/10
10 days (Belgium), 7/12-7/21/10
10 days (Spain), 7/12-7/21/10
10 days (Portugal) 7/20-7/29/10
I prefer different dates - contact me
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Choose:
Field Player
Goal Keeper |
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With your enrollment you must enclose a non-refundable $460 deposit to reserve your position.
An installment payment plan is available. Checks are payable to Eurosoccer Academy of the USA.
Major credit cards accepted. Upon receipt of your deposit we will send you a complete information book and account statement.
EUROSOCCER ACADEMY of the USA
305 Steven Lane
Stroudsburg, PA 18360
Phone 570-629-2125
For faster processing, please fax this completed document to: (570) 629-2125 |
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