+-
* indicates required fields

Team Info

State Association*
Pro Affiliate*
Team Name*

Gender*
Season*

2015-2016 Age Group*

Team Home Town*

Team Web Site
Club Name*

Coach

Name*

Email*

Mobile Phone*

Director of Coaching

Name*

Email*

Mobile Phone*

Team Administrator

Name*

Email*

Mobile Phone*

2014-15 MRL Results

Team Name used in 2014-15 :
Gender:
2014-15 Age Group:
Tier:
Record:
Wins:
Losses:
Ties:



2014-15 Other Team League Accomplishments (Do not include tournament results)

2014-15 State Cup Team Results

Where did you place in the 2014-15 Age Group? (for the 2015 regionals)

Coaches

List any coaches associated with this team and their highest U.S. Soccer license or other certification level (Each MRL team roster must have listed a coach holding a minimum of a National C US Soccer Coaching License or the NSCAA Advanced National Diploma):
Name: License/Certification:
Name: License/Certification:
Name: License/Certification:
Name: License/Certification:
Name: License/Certification:
Name: License/Certification:

Who Completes Form

Person completing this Form*:

Relationship to team*:

Midwest Regional League Agreement

We agree to abide by charter rules, policies, and decision of the Midwest Regional League. We have reviewed the MRL information and understand the commitment to the league for the coming season. In granting this permission to travel to and host Midwest Regional League games, neither US Youth Soccer nor the National State Association shall be liable for transportation, lodging or injury to person or property sustained in the course of the sanctioned event.Upon submission, a copy of this form will be emailed to the coach, the team administrator and the director of coaching to confirm receipt.

+-
* indicates required fields

Team Info

State Association*
Pro Affiliate*
Team Name*

Gender*
Season*

2015-2016 Age Group*

Team Home Town*

Team Web Site
Club Name*

Coach

Name*

Email*

Mobile Phone*

Director of Coaching

Name*

Email*

Mobile Phone*

Team Administrator

Name*

Email*

Mobile Phone*

2014-15 MRL Results

Team Name used in 2014-15 :
Gender:
2014-15 Age Group:
Tier:
Record:
Wins:
Losses:
Ties:



2014-15 Other Team League Accomplishments (Do not include tournament results)

2014-15 State Cup Team Results

Where did you place in the 2014-15 Age Group? (for the 2015 regionals)

Coaches

List any coaches associated with this team and their highest U.S. Soccer license or other certification level (Each MRL team roster must have listed a coach holding a minimum of a National C US Soccer Coaching License or the NSCAA Advanced National Diploma):
Name: License/Certification:
Name: License/Certification:
Name: License/Certification:
Name: License/Certification:
Name: License/Certification:
Name: License/Certification:

Who Completes Form

Person completing this Form*:

Relationship to team*:

Midwest Regional League Agreement

We agree to abide by charter rules, policies, and decision of the Midwest Regional League. We have reviewed the MRL information and understand the commitment to the league for the coming season. In granting this permission to travel to and host Midwest Regional League games, neither US Youth Soccer nor the National State Association shall be liable for transportation, lodging or injury to person or property sustained in the course of the sanctioned event.Upon submission, a copy of this form will be emailed to the coach, the team administrator and the director of coaching to confirm receipt.

Registration for the 2014-15 season has closed.

More information on the league can be found at www.midwestregionalleague.com.

Thank you for your interest in the MRL