Bettendorf Soccer Association

October Fest Registration 2010:

Team Name:

Club/Association:

Gender: BOY GIRL

October 8-9-10: U12 | U13 | U14 | U15 | U16

October 15-16-17: 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:

2009 Record: Wins/Losses/Ties

2009 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.