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Dear
Name,
Thank you for registering for the Alliance Kixx Program.
Payment options are on the next page.
Please print this confirmation page in
duplicate.
Keep one copy for your records and
send one copy with your payment within ONE WEEK to:
Alliance Soccer Club
P.O.B. 660
Iowa City, IA 52244
But first, please check the information you have submitted.
Player's Name:
PlayerFName
PlayerLName
Birth date:
DateOfBirth
Sex:
Sex
Grade:
Grade
Name of School:
School
Program (Day):
Program
Parent Name:
Name
Address:
Address
Address 2:
Address2
City:
City
State:
State
Zip code:
ZipCode
Home Phone:
HomePhone
Work Phone:
WorkPhone
Cell Phone:
CellPhone
Email Address:
Email
Parent or Guardian:
Guardian
Agree to Release Form?:
Agree
How did you find out about the Kixx Program?
FindOut
Comments:
SpecialRequests
If any of this information is incorrect, please click the back
button of your browser and change it. Thank you!
Click here to continue...
Revised: 11/07/05.
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