2011 Sedalia Select Fall Shootout  -  October 21-23, 2011

Team Application Form

Team Name:

Club Name:

Coach:

Street:

City:

State:

Phone1:

Phone2:

E-Mail:

Fax:

Team Contact:

Street:

City:

State:

Zip:

Phone1:

Phone2:

E-Mail:

Fax:

Past Tournament Results:

Tourn.#1:

Result:

Tourn.#2:

Result:

Tourn.#3:

Result:

 Age Division Requested (check one)

    Boys
U-9B
U-10B
U-11B
U-12B
U-13B
U-14B
U-15B
U-16B

    Girls
U-9G
U-10G
U-11G
U-12G
U-13G
U-14G
U-15G
U-16G

**The Tournament Committee reserves the right to combine age groups to complete brackets**

All Entry Frees are $350.00

Send checks or money order payable to Sedalia Select to:

Sedalia Select Soccer Club
Brad Grupe
2155 W. Country Club Drive
Sedalia, MO 65301