Wilmington Women's Soccer Association Registration
WWSA Spring 2012 Registration
Player Name: ________________________
Address: ___________________________
____________________________
____________________________
Phone number: _______________________
Date of Birth: ________________________
Email: ______________________________
Playing Experience/Level of Ability (circle one): Expert Intermediate Beginner
Desired Position: _______________________
Team Request: _________________________
(or indicate that you need to be placed on a team)
Spring 2012 registration deadline is February 15th. Cost is $45. After February 15th there will be a $15 late fee.
Please make checks payable to WWSA. Send signed registration form and check to:
Wilmington Women’s Soccer
2171 Talmage Drive
Leland, NC 28451
Participation Agreement:
I certify that all of the above information is correct. I hereby register for participation in the Wilmington Women’s Soccer Association. I have been fully informed that with my participation I assume all the risks and liabilities for my injuries and the injuries I may cause to others. Further, I hereby release, absolve, and hold harmless the Wilmington Women’s Soccer Association and all others listed hereafter; organizers, employees, officers, board members, coaches, referees, sponsors, supervisors, and landowners permitting the use of their land for soccer activities, any and all of them. I further agree to abide by the rules, regulations and decisions of Wilmington Women’s Soccer Association board, officers, and referees. I further state that I am at least 18 years of age and agree
to accept all disciplinary action taken by Wilmington Women’s Soccer Association board members, officers, and
referees.
Signature: ___________________________________ Date: ___________________________
Office Use Only:
Check # or Cash Amount