Men’s Over 35 Soccer League Registration

Team Name*

Team Color*

Captain Name*

First Last

Captain Phone*

Captain Email Address*

Co-Captain/Team Admin Name

First Last

Co-Captain/Team Admin Phone

Co-Captain/Team Admin Email Address

Billing Address*

Street Address Address Line 2 City State ZIP Code

At this time, I would like to pay*

My team's deposit only
My team's full payment amount

IMPORTANT PAYMENT INFORMATION: Your team must be fully paid BEFORE the second game, or else your team will forfeit until the balance is paid. Your team's balance MUST be submitted as one card payment, check, or lump sum of cash.

Credit Card*

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Total to Pay Now:

$0.00

Additional Notes or Comments

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Accept and Submit*

I certify that I am at least 35 years of age and that the information submitted here is correct to the best of my knowledge. I will notify Gorham Sports Center immediately if I discover at any time that any of the information provided by me is incorrect or inaccurate. I agree to pay the amount above and understand that any payments are non-refundable unless stated otherwise in writing by a GSC manager.

Phone

This field is for validation purposes and should be left unchanged.