U-20 Men _____ U-20 Women _____

U-23 Men _____ U-23 Women _____

TEAM NAME: _______________________________________________

MANAGER Name: _____________________________________________

Address:____________________________________________________

City: ___________________________ State: _______ Zip: ________

Phone: (____)_______________(H) (___)____________________(CELL)

E-mail: _________________________________________

ALTERNATE Contact: _________________________________________

Phone: (____)_______________(H) (___)____________________(CELL)

E-mail: _________________________________________

FIELD Name: __________________________________________________

Addr: ___________________________________________________

City: _______________________________ State: ____________

Return this application with the appropriate fee ($425 for Men and $375 for women), payable to NJSA, to:

NJSA

P.O. Box 9765

Trenton, NJ 08650