Winter/Spring Interest Form

	American Youth Soccer Organization Winter/Spring Interest Form

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Notes: (Do not re-submit this form to make changes)

If this form does not work properly email the below information to the Director of Secondary Programs .
To change your registration or ask questions, contact us here .

Please add me to your list of players interested in participating in the Region 85 Spring Select programs. I understand that I must have participated in the most recent Region 85 fall program to be eligible, and that submitting this form does not guarantee me a place in the program.

Program	Spring
Division	The division you played in this fall.
Your Region	Region where you participated in the most recent fall season.
First Name		Date of Birth mm/dd/yyyy
Last Name		Gender (you are) Male Female
Phone
Email

	My parent or other relative will referee Yes No If a relative volunteers to referee you will be guaranteed a spot on a team.