• Players Information

•      First Name:     

•                 Last:  

•     Fall 06 Team:  None U07 U08 U09 U10 U11 U12 U13 U14 U15 U16 U17 U18     Gender:  None Boys Girls   Please check one

•             Address:    

•                    City:  

•                  State: Zip:

•      Home Phone:  

•         Cell Phone: Emergency phone

•                  Email:

•              Session:  None Jul.31-Aug.3 Aug. 7-10 Other Please check one

•                Coach:  None Ahmed Gad Cindy Martillaro Ryan Jeskey Oleg Vatchev Leo Kulinczenko Batata Chuck Codd Kevin Lesch David Richardson Nino Da Silva Ryan Jeskey Hassan Minter Janet Albert Art Wywrot Greg Muhr Jake Truty Nilton Batata Please check one                               

• Requests:

• Medicine / Allergies :

•  

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• Payment Form :   Amount:  80.00    Please check one none Form faxed Cash Check enclosed C. Card

• • Cash  (can only be made in person at SEI / M-F 930-330pm)

  • Check Enclosed    or   Check in mail (Faxes only)

• C Card #: Exp Type none Visa Master Disc

•    

• Write check to: Sockers FC - Memo: Pre-season camps

• IMPORTANT

• Before submitting:

• Print this form and send it with your payment or simply fax it to:

• Sockers FC - Pre-season Clinics

• 545 Consumers Ave. - Palatine, IL 60074

• Fax: 847-394-9942 

• Your application will not be accepted until we receive your payment..

Office use only

Amount Paid:                   Date:     /       /           Receipt #                       Initials:

If you have questions or comments about this site please contact us.