International Clearance Waiver

Please Print or Type Clearly                                                                                                   

Players Last Name                                                        First Name                                                        Middle Initial     

Current U.S. Address                                                     City                                          State                            Zip

Place of Birth                                                                                                                                                                

                                                            City                                                                  Country/State

Birth Date                      /           /          

                        Month      Day      Year

I,                                                                                              , do hereby state as follows:

         Are you 11 years of age or younger?                                                  Yes                  No       

         Are you 17 years of age or older?                                                                  Yes                  No       

         Have you signed a contract with a professional team?                         Yes                  No       

         Have you received any money or other remuneration for playing

            soccer?                                                                                                 Yes                  No       

If you have answered all 4 of the above questions No, and are not coming to the United States to play in a tournament or friendly game and then return to your native country, you qualify for a waiver.  If you qualify for a waiver, submit this form, signed by all parties.  If you do not qualify for a waiver, an International Clearance Request form must be submitted.

By executing this form, I hereby represent that the information contained herein is true and correct.

By:                                                                                                                                          

            Signature of Player                                                                     Date

By:                                                                                                                                          

Signature of Parent or Guardian                                                   Date

By:                                                                                                                                          

            Signature of State Association Official                                         Date

Please complete and submit this form along with application fee of $10.00 by mail to:

U.S. Soccer Federation

Attn: Federation Services Department

1801 South Prairie Avenue

Chicago, IL  60616

312-808-1300

312-808-9263 Fax