New Jersey Soccer Association

APPLICATION

PLEASE PRINT LEGIBLY

Application Deadline is August 7, 2010.

Checks are to be made payable to the New Jersey Soccer Association.

Return the application below with the participation fee of $160.00 to:

New Jersey Soccer Association

P.O. Box 9765

Trenton, NJ  08650

Name_________________________________________________________

Address _______________________________________________________

City ___________________________________________________________

State ____________________________ Zip Code ______________________

Date of Birth: _____________________ Country of Birth: ____________________________

Home Telephone  (_______) _________________________

Cellular Telephone  (_______) _________________________

Fax Telephone  (_______) _________________________

Email Address________________________________________________________________

Relationship to any Adult soccer affiliated member ( please give name of team, league and position with such organization)

_________________________________________________________________________________

_________________________________________________________________________________

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 PLEASE  MAIL YOUR APLICATION WITH YOUR RESUME DESCRIBING ANY PLAYING  AND/OR  COACHING EXPERIENCE.