Association Name:

Association Representative

 First Name:  Last Name:
 Street Address:
 City:  Postal Code:
 Primary Phone: - -  Business Phone: - -
 Association Website:

Voting Delegate(if same as representative, click here to copy from above fields)

 First Name:  Last Name:
 Email:  Primary Phone: - -

Are you part of a recognized loop?

 If yes, what loop:

How many teams in each division?

 [Sel] 9U [Sel] 11U [Sel] 13U [Sel] 15U [Sel] 18U [Sel] 21U
 Total number of teams:
Total Amount ($):
Session Year

Total number of teams x$100

Minimum $100

Enter your billing information

 Credit Card Details 
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