InfoSport:

2007 Men's Pro Soccer Combine Application

Please print out this page, complete the form, and mail or FAX to InfoSport along with the application fee.

PERSONAL DATA:

Name: _________________________     Date of Birth:__________  

Current Phone: _________________________  Permanent Phone: _________________________

Pager: _____________________________ Mobile Phone: _____________________________

email address: ___________________________________________

(please make sure this email address is valid and that you have frequent access to it)

Current Mailing address: __________________________________________________

City: ________________________ State: _____ Zip: __________ Valid Until: __________

Permanent Mailing address: __________________________________________________

City: ____________________________________ State: _____ Zip: __________

Positions Played (list in order of dominance - list a maximum of two positions):

Height: __________ Weight: __________

Size of Jersey (circle one):    M     L     XL    XXL

(we make every attempt to provide you the requested size, but we cannot guarantee it)

Any injuries during career? (List type, date and result):

Any surgeries?

List any pertinent medical conditions (asthma, diabetes, allergies, etc.)

Do you have a passport?      Yes or No      (circle one)

Country of Issue:_______________ Expiration Date:__________

Do you have dual citizenship with another country? If so, which country?

If you are not a US citizen, please indicate your residency status:

Please provide the BIRTHPLACE for each of the following:

Yourself: ______________________________

Mother: _______________________________

Father: ________________________________

Maternal Grandmother: ____________________

Maternal Grandfather: _____________________

Paternal Grandmother: ______________________

Paternal Grandfather: _________________________

Your Agent’s Name: _________________________

Agent’s Phone: ________________________ Agent’s FAX: _____________________

Agent’s Address: __________________________________________________

City: __________________________ State: _____ Zip: _________________

Agent’s email address: _______________________________________________

Agent's web site: www._________________________________________

COLLEGE SOCCER EXPERIENCE:

College attended: ________________________________ Head Coach:  ____________________

Coach's Office Phone Number:________________________________

Coach's email address: _____________________________________

Sports Information Director: _________________________________

SID Office Phone: _______________________ SID email address: __________________________

Final Season of eligibility: __________

(Participation in this event could impact collegiate eligibility. If you have eligibility remaining, consult with your coach or athletic director.)

College Stats/Honors/Records:

CLUB SOCCER EXPERIENCE:

PROFESSIONAL SOCCER EXPERIENCE:

PAYMENT INFORMATION:

Calculate your total:

Combine Fee: $295_____

Spectator/Guest Pass $3 each: ____ x $3 each = ______ (passes are good for the entire event)

TOTAL ENCLOSED $___________

Select Method of Payment: NO PERSONAL CHECKS ACCEPTED

o Certified Check or Money Order enclosed (made payable to InfoSport, Inc.)

o American Express, Visa or MasterCard

Credit Card Number: ________________________________  Exp. Date: ______________

Name as it appears on the card:________________________________________________

Billing Address: _____________________________________________________________

City: ____________________________________ State: _____  Zip: _____

Signature of Card Holder: ____________________________________

(NOTE: CREDIT CARD ORDERS WILL BE BILLED A 5% PROCESSING FEE, BASED ON THE TOTAL BILL)

Mail your application, registration fee and any supporting materials to:

InfoSport, Inc., P.O. Box 935, Media, PA 19063, USA

Or FAX to: 215-689-1479

Only a limited number of players at each position will be accepted.  Those players that apply after their position has

been filled will be allowed to enter a waiting list or have their materials returned, with no charge.

ONCE A PLAYER HAS REGISTERED & BEEN ACCEPTED, NO REFUNDS WILL BE GIVEN. NO EXCEPTIONS.