Eurosoccer Academy of the USA

Name:
Address 1:
Address 2:
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State:	Zip:
Home Phone:	Other Phone:
Email Address:
Fax:
Date of Birth:
Age:
Sex: Male Female
Height:
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Position:
T-Shirt Size:
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School/College Name:
Address:
Coach's Name:
Team:
High School: District State Regional National Club Name:
College: Div I Div II Div III
Achievements:
Goals:
Please enroll me in the:
Individual Players Program One month (Romania & Belgium), 6/23-7/21/08 3 weeks (Romania), 6/23- 7/13/08 3 weeks (Belgium & Portugal), 7/12-8/02/08 2 weeks (Portugal), 7/20-8/02/08 6 weeks (Romania, Belgium & Portugal), 6/23- 8/02/08 10 days (Portugal), 12/27/08-1/05/08 One month (Romania-Portugal), 6/23-7/21/08
Jr. HS, HS, College & Club Team Program 3 weeks (Belgium & Portugal) 7/12-8/02/08 3 weeks (Romania), 6/23-7/13/08 2 weeks (Portugal), 7/20- 8/02/08 10 days (Belgium), 7/12-7/21/08 10 days (Portugal/Spain) 12/26/08 - 1/04/09 10 days (Portugal) 3/13-3/22/08 10 days (Portugal) 7/12-7/21/08
Choose: Field Player Goal Keeper
With your enrollment you must enclose a non-refundable $460 deposit to reserve your position. Installment payment plan available (our payment plan started on 8/20/07). 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