TO BE LISTED ON THE CLUBS BY AREA LIST & ON THE CLUB DROP DOWN LIST when members are registering; this form must be completed yearly.

The Club Director must have the following before being added:
-- a current season membership
-- have a current USAV background screening (Allow 2-4 work days for new screening)
-- completed the Junior Club Personnel Code of Ethics
-- completed SafeSport training and certification

Make sure to add the 'QC' if you want to share players among the Quad City affiliated clubs for in region events only.
Club Name *
Returning clubs list same as previous. New Clubs must have a unique name. New Club names may be subject to change to avoid confusion.
Your answer
Club Status *
Type of Club *
Mega Clubs list names of sub clubs
Your answer
Club Website
If you have a club website please list here.
Your answer
City or Area *
List the City or Area where most practices are held.
Your answer
Area of Region *
New Club Director *
Club Director's Name *
(First Name, Last Name)
Your answer
Club Director's Email *
Email to be posted.
Your answer
Street Address *
Address to be posted.
Your answer
City *
Your answer
ST *
Your answer
Zip *
Your answer
Club Phone Number *
Number to be posted.
Your answer
Director's Cell Phone
Your answer
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