BCSA FALL LEAGUE TEAM ENTRY
ABOUT THE TEAM: (DO NOT REPEAT THE CLUB NAME IN THE TEAM NAME-IT WILL BE ADDED AUTOMATICALLY!)
Club: TTeam Name: TAge Group:
Level of Competition: Jersey Color: Is this team entering State Cup?:
Home Field: Prefer to play:
Dates Team Cannot Play: (Limit of three) 1.X XX2.X XX3.X
ABOUT THE CONTACT TO BE LISTED WITH THIS TEAM:
Contact Name:
Street Address:
City: XState:XXZip:X
Primary Cell Phone: XSecondary Cell Phone (Not Published):X
E-Mail Address:
ABOUT THE PERSON SUBMITTING THIS ENTRY:
Submitted By:
Submitting E-Mail:

BY CLICKING THIS SUBMIT BUTTON, I CERTIFY THAT MY CLUB KNOWS ABOUT
AND HAS AUTHORIZED THIS TEAM.

Please note that any entry in the state cup field does not automatically enter your team into State Cup!

If you want a copy of this entry, please print it from your browser BEFORE hitting the submit button.

Please hit the submit button ONLY ONCE. It may take up to 30 seconds to process this information.
A copy of this information will be sent to the Submitting Email Address.