Team Name: _________________________________________________________________________

Age Category: ( ) Senior (  ) Under 18 (  ) Other: ____________________________ ie: Canada Games

Division: (  ) Premiere (  ) First Division

Team Manager: _______________________       Address: ________________________________

City:  _____________________________      Postal Code: ________________________________

Phone #: ___________ Cell Phone #: _______________ Fax:____________ Email: ______________________

Coach: ______________________________  Address: __________________________________

City:  _______________________________  Postal Code:________________________________

Phone #: __________ Cell Phone #: ________________ Fax: ___________ Email: _______________________

Shirt Colors: _______________ Shorts Color: ___________ Sox Color: __________________________

Club Affiliation: ______________________________________________________________________

Club President: _______________________________  Address:___________________________________

Phone #: ______________ Cell Phone #: _________________ Fax: ________________

Home Field Name: ________________________ Location: _______________________________

(Game nights will be Mondays and Fridays)

Dates Home Field Not Available : ____________________________________________________

Dates when you will be unable to field a team (ie: Graduations, prom nights, tournaments etc.): ________________________________________________________________________________

League Fee of $125.00 and performance bond of $100.00 (Total of $225.00) must be submitted to the Senior Women’s Soccer League c/o Liz Doucette by May 24, 2005.

Teams must register with the PEISA through their club affiliation prior to being accepted into the league.

I hereby apply to the PEI Senior Women’s Soccer League (PEISWSL) to register the above team in the PEISWSL for the upcoming season. This team hereby agrees to comply with the Constitution and Bylaws of the PEISWSL and of the PEI Soccer Association.
________________________________ ______________________________ _____________ _________
Team Rep. (print)                                             Signature                                                         Title                     Date

Witness: _______________________________ Date: __________________________