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Your Information (From the person filling out this
registration form) |
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Your Name
(First and Last) |
Your Email Address |
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I am Signing up as an Individual to participate in
the following programs : |
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Player Information |
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Player Name ( First, Last, Middle): |
Date of Birth |
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Home Address |
City, State ,
Zip |
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Father's Name ( First and Last) |
Father's Email Address: |
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Father's Phone /
Cell Phone |
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Mother's Name ( First and Last) |
Mother's Email Address: |
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Mother's Phone /
Cell Phone |
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Let us know about how your player.
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Payment Section Information |
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| I would like to order
additional Futsal Balls at a Discounted Registration Price
in Advance. |
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| I am
interested in Purchasing Joma Futsal Shoes at the
Discounted league price.
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I am
paying
$150 at this
time Via Check or Money order.
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Check
Date:
Number:
Amount:
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Balance of registration fee
are due on day one of the Program start date.
It is recommended that each player have at Futsal Ball
and Joma Futsal Shoes to train and play in. Sneakers will not be allowed.
A Check for $150 and a copy of this registration form (which you will
receive via email) must be sent to
InSoccer , 66 Anawan
Street, Rehoboth Massachusetts 02769.
We look forward to seeing in our programs.
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