MSA Camp
2008 Field Player & Goalkeeper Registration
Ages 10-18
Complete the form below, then press the "Submit" button.
Midwest Soccer Academy Accepts Check or Mastercard/Visa Payment.
Required Fields are Marked with a "*" Use Proper Punctuation, Please Turn Off All Caps.

All MSA campers receive (2) t-shirts and a water bottle.

TEAM REGISTRATIONS***
**Is Your Team is Registering for a Camp? STOP HERE. Email Tony@MidwestSoccer.net for a Team Discount Code (Minimum of 6 Players Required) **

Select the Camp Session You Would Like to Attend*:
Personal Information:
Please Note: The Email address below will be used as the main means for all future camp communications.
Proper Punctuation is Required, i.e.: "John Smith", NOT "john smith" or "JOHN SMITH"
First Name* Last Name*
Date of Birth*
Month    Day    Year   
Street Address*
City, State, Zip*
Contact Email Address*
Home Phone*
( ) - -
Gender*
 School Grade (as of 01/01/08)* ie: Fifth
Have you attended a Midwest Soccer Camp before?*
Yes No		 T-Shirt Size*
Youth Large
Adult Small Adult Medium
Adult Large Adult X-Large
Position*
Field Player Goalkeeper 		 
How will you be Attending?*
Resident Commuter 		Roommate Preference (2 per room)
enter 1 preference only
Club
 Parent Name(s):
Products (Optional)
Select Items to Add to Your Registration
Extra Camp T-Shirt: 100% Cotton with MSA Logo $15.00 Add
The Dutch Touch Sack Pack: Great for camp week $12.00 Add
Official Camp Ball: Match quality size 5 ball with $35.00 Add
Payment Information

Discount Code:
Leave Blank if you do not have a "Discount Code"

Your Camp Fee: $
Deposit: $

Payment Method:* Check Credit Card

Payment Option: Pay in Full Now Pay Deposit Only Payment Plan

If Payment Plan is allowed for this camp, then you may select it above.
Payments will be divided into equal payments with a a $5 processing fee for each payment.
The first payment is now.
The 2nd payment, which will be on 12/15/2009.
The last payment will be $ plus the processing fee.

Payment Plan must use Credit Card. Be sure you use a credit card that does not expire until after all payments are made. Thank you.

Amount of This Payment: $

Name as it Appears on Credit Card Credit Card Type
MasterCard Visa
Credit Card Number


 Credit Card Expiration Date
 /
Credit Card Holder's Street Address:
Credit Card Holder's Zip Code:
Agreement for Electronic Submission
I/we (above indicated) hereby acknowledge that I/we have reviewed this form and caused it to be electronically executed with the intent to be bound to the terms contained herein.*
 



Please click ONLY ONCE on the Submit button above.
Your Credit Card will be charged each time you press submit.
Sometimes, it takes a few seconds for the form to be processed. Thank you.
Please email to Info@MidwestSoccer.net if you have any problems.


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