Bettendorf Soccer Association

October Fest Registration 2011:

Team Name:

Club/Association:

Gender: BOY GIRL

October 7-8-9: U12 | U13 | U14 | U15 | U16

October 14-15-16: U8 | U9 | U10 | U11

Coach/Manager:

Address:

City: State: Zip:

Home Phone:

Cell Phone:

Email Address:

Fair --------------------- Average ----------------Outstanding
Team Rating (10=Outstanding): 1 2 3 4 5 6 7 8 9 10

Competition:

2011 Spring Record: Wins/Losses/Ties

2011 Highlights / Notes:

Submitting this registration form does not ensure a spot in the BSA October Fest Tournament. To verify the participation of your team you will receive a confirmation notice in the mail. If you have any questions, call Thomas Jarrett at 563-355-4889(after 6pm in the evening)

Make checks payable to:
The Bettendorf Soccer Association

Mail checks to:
Bettendorf Soccer Association
P. O. Box 671
Bettendorf, IA 52722
Check must be received BY ENTRY DEADLINE.