Midwest Conference Girls Club Application

* - denotes required fields

Club Name *

Club Website *

Division Selection *

POINT OF CONTACT

Name: *

Title: *

Email Address: *

Primary Phone Number: *

GIRLS DIRECTOR OF COACHING/CLUB DIRECTOR

Name: *

Title: *

Email Address: *

Primary Phone Number: *

CLUB DIRECTOR/TECHNICAL DIRECTOR

Name: *

Position with Team: *

Email Address: *

Primary Phone Number: *

GENERAL CLUB INFORMATION

Year Club Was Founded: *

List the total number of girls teams within your club in the following age groups:

8U to 12U *

13U *

14U *

15U *

16U *

17U *

18U *

19U *

List all of the full-time coaches within your club and their U.S. Soccer license levels: *

Please explain why your club deserves acceptance into the Club Division. *

FACILITIES INFORMATION

Names of complexes: *

Total number of full-size grass fields: *

Total number of full-size synthetic fields: *

How many lighted grass fields? *

How many lighted synthetic fields? *

TEAM INFORMATION

Did any of your girls teams participate in the Midwest Conference in 2019-20??

Yes
No

List the girls teams and their team record and level of play (Premier I, Premier 2, First Division)

Did any of your girls teams participate in the National League in 2019-20?

Yes
No

If yes, list the National League girls teams.

If admitted into the Midwest Conference Club v Club competition, please check the teams that your team would provide to the competition. Please note that you must compete in ALL ages (the only exception may be a potential combined 18U/19U team that would play 19U).

15U

16U

17U

18U

19U

Would your club prefer a 18/19U age group as opposed to separate 18U and 19U age groups?

Yes
No

AGREEMENT

I verify that the applying club will be properly registered with the applicable US Youth Soccer State Association for the 2020-21 seasonal year. All information in this application is correct, and the club understands that any misrepresentation of team accomplishments may result in the club being disqualified from participation.

Name of team official submitting this form: *

Title: *

Primary Phone Number: *

Email Address: *