US Deaf Men's Soccer Team Information Form (2017)
Form to be completed by all players, coaches, and staff.
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
mm/dd/yyyy
Your answer
Home Address *
ex: 2800 Olympic Parkway
Your answer
Apt
ex: Apt #313
Your answer
City *
ex: Chula Vista
Your answer
State *
ex: CA
Your answer
Zip Code *
ex: 91915
Your answer
Primary E-mail Address *
Your answer
Mobile Phone *
ex: xxx-xxx-xxxx
Your answer
Other Phone, if available (House, Work, etc.)
ex: xxx-xxx-xxxx
Your answer
Training Shirt Size *
select from list
Training Shorts Size *
select from list
Do you plan to attend the training / tryout camp from 7/6/17-7/9/17? *
select from list
What is your current status/occupation? *
What level of soccer are you currently playing? *
What position do you play? *
check all that apply
Required
Citizenship *
Please select the options that apply to you. You must be a US Citizen, or in the process of obtaining US Citizenship, to participate as a player at all USADSA sanctioned events.
Required
What is your hearing loss in your better ear? *
Please select the option that applies to you. Your hearing loss must be greater than 55db in your better ear to participate as a player at all USADSA sanctioned events.
Gender *
# of Hotel Nights *
Please select which option describes your arrival time:
Australia Invitational Tournament *
If selected to the US Deaf Men's National Team, will you be able to attend Australia (11/30/17 - 12/10/17)?
Additional Notes
Optional: Feel free to provide additional contact details or comments. Do not ask questions here, as they will not be answered.
Your answer
PAYMENT
After submitting this form, please visit www.usdeafsoccer.com and click Donate to make your payment.
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