SC AMATEUR SOCCER ASSOCIATION TEAM REGISTRATION FORM FOR CENTRAL LEAGUE Please make 1 payment to "CL-SCASA" The cells below are available for Team Rep. modification and use if needed, but will not print.
www.scamateursoccer.org $335.00 TOTAL AMOUNT DUE FOR BOTH You can copy to a new sheet if you want to print or format the information.
STATE ASSOCIATION: SCASA INITIAL ROSTER (date): $335.00 TOTAL AMOUNT DUE CL Total CL CL Team Total Fee Referee (Ref fees are paid at
LEAGUE: Central League UNIFORM COLOR: Primary: LATEST UPDATE ROSTER (date): $0.00 TOTAL AMOUNT DUE SCASA Player fees Fee Due Due CL Fees/team the field by each team)
TEAM NAME: Secondary: SEASON: Fall 2012 Please sent payment to CL-SCASA at: $60.00 $275.00 $335.00
TEAM REPS: (Principal Team Rep) - if not a player please provide contact info below DIVISION: Pick Type 3202 Fernandina Rd. 275.00 must be made out to ICRC
(Secondary Team Rep) - if not a player please provide contact info below LEAGUE TYPE: 6v6 Columbia, SC 29210 the remaining balance need to be out to Central League SCASA
SEASONAL YEAR: 12/13
TELEPHONE SCASA Player Payment Information CL Player
NAME NAME PLAYER Birthdate ZIP Drop
MI ADDRESS CITY E-Mail Add
(First) (Last) PASS No. mm/dd/yy CODE Home Cell Work SCASA Fee Due Season Paid League Paid Fee Due
** Dual Fee: Must be paid when a player registers in more than one Regional League. After an individual has been initially registered by SCASA for $25 in a Regional League, the cost will be $5 for each additional Reagional League membership during
the seasonal year. The SCASA Seasonal Year membership begins Sept. 1 and ends Aug. 31. *A $25 fee will be assessed for all returned checks. All SCASA fees due must be paid before a player or team will be registered to play.
SCASA CERTIFIED ROSTER & GAME DAY CARD
SOUTH CAROLINA AMATEUR SOCCER ASSOCIATION
THE SCASA REGISTRAR'S STAMP MUST BE PRESENT BELOW THE LAST NAME LISTED TO BE VALID.
VERIFY EACH PLAYER WITH THEIR CURRENT SCASA CERTIFIED PLAYER PASS.
LEAGUE: Central League TEAM NAME:
SEASON: Fall 2012 LEAGUE TYPE: 6v6
DIVISION: Pick Type ROSTER ISSUE DATE:
TEAM REPS: GAME DATE
PLAYER PASS # JERSEY
FIRST NAME MI LAST NAME D.O.B. #
(assigned by SCASA)
NOTE: League Officials may approve the use of the SCASA alternate check-in procedure when deemed necessary.
Team Rep Signature: ___________________________________