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Team Membership Application - Ontario Futsal Association

MEN WOMEN BOYS GIRLS

AGE GROUP: U -

Club Name:
required

Team Name:
required

Name of Contact:
required

Street Address:
required

City:
required

Province:

Postal Code:
required

Email Address:
required

Home Phone:
required

Office Phone:

Fax:

ALL CORRESPONDENCE OR CONTACT WILL BE MADE TO THE PERSON NAMED ABOVE!

Name of Coach:
required

Colour of Shirts:
required

Colour of Shorts:
required

Player N0.1

First Name:		Last Name :
Address:		Jersey #:
Birthdate:	- -

Player N0.2

First Name:		Last Name :
Address:		Jersey #:
Birthdate:	- -

Player N0.3

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Address:		Jersey #:
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Player N0.4

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Player N0.5

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Player N0.6

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Player N0.7

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Player N0.9

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Player N0.10

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Player N0.11

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Player N0.12

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Player N0.13

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Player N0.14

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Player N0.15

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Player N0.16

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Additional Comments:

If you have any questions, here's our contact information:

Ontario Futsal Association
Affiliated with the Canadian Futsal Association

71 South Valerie Street,
St. Thomas, Ontario, Canada N5R 1B1
phone 519-631-5852
fax 519-631-8262
email: r.luft@sympatico.ca

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