Application for the AYSO Region 9 Pot O' Gold Tournament

Please complete ALL requested information on this application.
If you are sure you do NOT need to make any changes, Print this page from your browser and get your RC's signature at the bottom of the page.
To submit this Application to the Pot O Gold, click on <Add>.
Incomplete information will result in an Error message; your Team Application will not be sent until it is complete and you have clicked on <Add>.

   Team:
S/A/R Section:   Area:   Region:
City
Team Name
Division Age Group:   Gender:
Team Colors Jersey:   Shorts:   Socks:
Your Region's Commissioner - Name 
How can we contact the RC
(e-mail address, phone number)?		  
Regional Treasurer Name
(for refund checks)		  
Address (for refund checks)  
City:   State:   Zip:
   Coach:
Name First:   Last:   AYSO Volunteer ID#: 
Address  
City:   State:  Zip:
Phone Numbers (nnn) nnn-nnnn Evening:   Other:  
E-Mail Address  
 AYSO Coach Certification  Level    Safe Haven Date (mm/dd/yyyy) 
   Asst Coach/Other Team Contact:
Name First:   Last:   AYSO Volunteer ID#: 
Address  
City:   State:  Zip:
Phone Numbers (nnn) nnn-nnnn Evening:   Other:
E-Mail Address
Team Rating Information (ALL FIELDS ARE REQUIRED!; to be completed by the Team Coach):
This team is a ...   Rate your team (honestly!):
Number of Allstars on this team:  Number of older players  ...and younger players
How did this team place (1st, 2nd, 3rd, etc) in the:  Area Playoffs?    Section Playoffs?    Tri-Section Playoffs?

1. Be sure that ALL information is complete
2. BEFORE YOU CLICK THE <ADD> BUTTON BELOW!
Use the Print function of your browser to print this Form for Coach & RC signatures (Page Setup:  Portrait, .25" margins)
3. Click here to send Team information to POG staff---->  

Coach Signature (blue or red ink) ________________________________  Date ___/___/______

Regional Commissioner:  Print Name ____________________________    
Signature (blue or red ink) ________________________________  Date ___/___/______

Address:  _______________________________________  City:  ___________________________ 
State:  ____   Zip:  __________________

Best way to contact you (the R.C.) (evening phone number; e-mail address): 

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