Northwest Conference Boys Club Application

* - denotes required fields

Club Name *

Club Website *

POINT OF CONTACT

Name: *

Title: *

Email Address: *

Primary Phone Number: *

BOYS 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 boys 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 boys teams participate in a National League Conference in 2019-20 or 2020-21?

Yes
No

If yes, list the boys teams and their team record in National League Conference competition.

Did any of your boys teams participate in the National League Playoffs in 2020-21?

Yes
No

If yes, list the participating boys Playoff teams.

If admitted into the Northwest Conference Club vs. Club competition, please check the teams that your team would provide to the competition.

13U

14U

15U

16U

17U

18U/19U

AGREEMENT

I verify that the applying club will be properly registered with the applicable US Youth Soccer State Association for the 2021-22 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: *