Express Beach Soccer Fest June 27-28, 2015 @ McGee Beach, CC, Texas Sponsored by Corpus Christi Parks & Recreation 2015 Application Express Early Registration Deadline 05/01/15 ($25 Discount) Regular Registration Deadline 06/13/15 – After Late Fee $50.00 Soccer Club LEVEL OF PLAY (Check Appropriate Lines per Your Team's Registration) Gender Recreational Teams Select / Co-Ed Teams Adult Co-Ed Teams ___ Co-Ed ___ Boys (ages U8 - U14) ___ Recreational (U10-U14) (ages U11 - U19) ___ SII and/or Div I (Select) ___ Under 25 ___ Under 30 ___ Girls ___ Fun (U7 & U8 only) ___ Div II (Competitive) ___ Over 30 ___ Under 40 AGE GROUP Check one: (Failure to designate the correct age group could disqualify your team) Age group is according to oldest player on the team (except Adult CoEd _ U7 (8/1/07-7/31/08)* _ U8 (8/1/06-7/31/07) _ U9 (8/1/05-7/31/06)* _ U10 (8/1/04-7/31/05) U11 (8/1/03-7/31/04)* U12 (8/1/02-7/31/03) _ U13 (8/1/01-7/31/02)* _ U14 (8/1/00-7/31/01) U15** (8/1/99-7/31/00)* U16** (8/1/98-7/31/99) U17** (8/1/97-7/31/98)* U18** (8/1/96-7/31/97) U19** (8/1/95-7/31/96) *NOTE: Pure age groups will be formed if there are a sufficient number of teams registered. Check here if you are requesting to play up one age group HIGHER than your normal age group. ** Under 15 and Older Teams Will Be Co-ED ** REGISTRATION INFORMATION Team Name: ______________________________________ Primary Jersey Color: ____________________________________ Coach _______________________________________ ____ Manager: ______________________________________________ Address __________________________________________ _ Address: _______________________________________________ City _______________________ State ______ Zip _______ _____________ City _____________________________ State ______ Zip: _______ Home Phone (______) _________________________________ Home Phone (______) _____________________________________ Fax Number (______) _________________________________ Fax Number (______) _____________________________________ Cell Phone (______) _________________________________ Cell Phone (______) _______________________________________ E-mail Address _______________________________________ E-mail Address ___________________________________________ WITH WHOM DO YOU WISH US TO CORRESPOND: ______COACH ______MANAGER MAIL TO: CHECKLIST: Express Soccer Club P O Box 61182 __ Official Team Roster with Coach's Signature __ Check or Money Order for appropriate entry fee made payable to Express U8s = $200, UlOs = $300, U11s -Ul4s = $350, U15s - U16s = $400, Ul7s-Ul9s = $450, Adults = $450) Corpus Christi, TX 78411 Earlv Registration Discount of $25 if received on or before May 1, 2015. Late Fee of $50 for Applications Received after June l3, 2015. Coach's Signature ___________________________________________________________________________________ _ FOR TOURNAMENT USE ONLY Date Received ____ ______________ Check/Number: _________________ Signed Application: ________ Money Order:______________ Initial Roster: ________ Final Roster: ________ Waivers: ________ Amount: _____________ Team Number: _________