Tennessee State Soccer, 2500 Excutive, Park Drive, Cleveland, TN .37312 | (423) 559-1150 (800) 367-8772

The Game for All Kids!

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TENNESSEE STATE SOCCER ASSOCIATION

2500 Executive Park Dr. lCleveland, TN 37312 l (800) 367-8772

 

Association Age/Sex Division _____Season:___ Team Name Area Code (_____)

 

 

Social Security #

 

First/Last Name

 

Address

 

Zip Code

 

Phone

Birthdate

Required

 

Sex

 

Coach

 

 

 

 

 

 

 

H

W

Email

 

 

 

 

 

Asst

 

 

 

 

 

 

 

H

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Email

 

 

 

 

 

Asst

 

 

 

 

 

 

 

H

W

Email

 

 

 

 

Manager

 

 

 

 

H

W

Email

 

 

 

 

 

 

ID #

 

First/Last Name

 

Address

 

Zip Code

 

Phone/Email

 

Birthdate

 

Sex

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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18

 

 

 

 

 

 

 

 

 

 

 

 

 

 

* It is not necessary to enter the City or State if the appropriate Zip Code is used. If your area has a new Zip, enter the City only once.

 

Proof of age is available for inspection for teams entering state tournament or Interstate competition. I hereby certify that the above information is true and correct. Revised 9/25/01

 

DATE: COACH: REGISTRAR: