Lake Country Soccer

Lake Country e-Registration System

Team Registration Form

Please submit your complete Team Registration online.
Print two copies of the confirmation page.
Submit one copy along with league registration fee to Lake Country Soccer.
Keep one copy for your records.

Individual player registration forms MUST be completed for each player on the team,
which includes the “MYSA Registration” form and the “Medical Release” form.

Session/Registration Information
Session:	Type of Registration:*
Team Information
Team Name:*
Age Group:*	Gender:*
Playing Level:*	Scheduling Requests (No Guarantees):
Team Contact/Coach Name:*	Team Contact/Coach Phone:* - -
Team Contact/Coach Address:*	Team Contact/CoachCity, State, Zip:* City: St: Zip:
Team Contact/Coach Email Address: *	Confirm Email Address: *
Questions or Comments:
Payment Information
Payment by check only. Make check payable to "Lake Country Soccer". Please be sure to write in the memo section, the program or activity being paid for. Please mail a copy of the registration confirmation page and your check to: Lake Country Soccer 2334 E. Pythian Drive Springfield, Missouri 65802

Team Registration Submission Agreement
	I/we (above indicated) hereby acknowledge that I/we have reviewed this form and caused it to be electronically executed with the intent to be bound to the terms contained herein.

Note: Please do not press the "Submit Registration" button more than once.
Doing so may result in your credit card being charged twice.