Rep Team Evaluation Registration 2009/2010

This FORM will not work on MAC/Apple Computers!!

You will receive an email with a copy of your registration information. This will confirm we have received your registration.
If you do not get a confirmation email you are not registered.
Please complete all information marked as (*)

Player Information
Player First Name (*)
Please enter your First Name
Player Last Name (*)
Please enter your Last Name
Birth Date (mm-dd-yyyy) (*)
Enter Valid Birthdate (mm-dd-yyyy)
Address (*)
Please enter your Address
City (*)
Please enter your City
Province (*)
Please enter your Province
Postal Code (*)
Please enter your Postal Code
Primary Phone Number (*)
Please enter your Primary Phone Number
Alternate Phone Number (*)
Please add an alternate telephone or cell number
Your Primary Email (*)
Please your primary email address
Your Alternate Email

Player History
Last Year Club (*)
Please enter name of the club you played for last year.
Last Year Team Name (*)
Please enter name of the Team you played for last year.

What division did you play last year?
Last Year Division (*)
Please select last year Division.

Evaluation Sessions
Which age level evaluation session will you be attending?
(check all that apply)
Age Level (*)
Please select an Age Level

Which evaluation division(s) will you attending?
(check all that apply)
Evaluation Level (*)
Please select at least one evaluation level

Preferred positions? (Check all that apply)
Position (*)
Please select at least one of the coaching positions.
Additional Comments?

I agree to abide by the Club Guidelines and Process for Rep Team player evaluation and selection.
Select (*)
Please add a value for Select.
Please review your information.
When satisfied enter the security code and click the REGISTER button below.
Enter Security Code (*) Enter Security Code
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Please enter the security code.
Click When Done
SEMIAHMOO SOCCER CLUB P.O. Box 75367, White Rock, BC , V4B 5L5