International Soccer Club Mississauga

Mississauga Soccer - Rep Development Program at Erin Mills & Britannia

From June 10th 2019 until September 9th 2019

UserID
Returning Player*
Player Name *
Last: First: MI:
Address*
City*
Postal Code*
Phone Number*
Cell Phone Number
E-Mail*
Date of Birth month (m/d/y)
OSA Registrant # if applicable
Gender*
Parent/Guardian Name*

Has the player ever registered to play soccer in any country? *

We need to evenly spread players from every skill level onto each team. We strive to balance the strength of all teams to create a challenging & enjoyable environment. Please be realistic in choosing the following:
Skill
Coach/Team Mate
Requests Or Comments
Type of Credit Card*
Name on Card*
Card #
(leave no spaces)*
CVD # (on back of card)
Expiry*
Payment Amount $350 + HST
                        I agree with the Terms and Conditions of the Waiver of Liability & Refund Policy*
                        I confirm that My Name Typed on the Registration Form is my Elctronic Signature Accepting the Waiver of Liability and Refund Policy
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