| MIDDLETOWN YOUTH SOCCER ASSOCIATION P.O. BOX 1199 MIDDLETOWN OH 45042 SPONSOR REGISTRATION 2007 Name of SPONSOR ________________________________________________ Address________________________________________________________ City________________________ State_____________ Zip_______________ Contact Person _________________________________________ Phone Number _________________________________________ Name of Team to appear on shirt ___________________________ Team Sponsorship Options Select one ______ We will Sponsor a team to be determined by the MYSA Board ______ We prefer to select the team we sponsor Will Registered trademark or logo be used? Yes No (circle one) If yes, please enclose trademark/logo with this application, even if previously submitted. Team Colors First Choice ___________________ Second Choice _____________________ If you select Sponsorship option #2 As a sponsor, you may sponsor a child to be on your team; example: your child, an employee’s child; a relative’s child. You may also pick a coach (coaches must be approved by MYSA) and have his/her child on your team. Only 2 children may be involved. Please fill out Player Registration forms for each child involved & mail the forms along with sponsor form so that we can ensure that they can be placed on the same team. Name of Child________________________ Birth Date_________ Sponsor child_____ Coach Child_____ Name of Child___________________________ Birth Date ____________________ Sponsor child________ Coach Child___________ All sponsor & Registration fees must be paid prior to June 15 for Option #2 Sponsor Fee: $250.00 - Make check payable to : Middletown Youth Soccer Association, Inc If you have any questions regarding payment please contact Kelli Grimes Please return this form to the above address and Thank You for supporting Middletown Youth Soccer |