2012 Northeast Regional Futsal Championship

The 2012 Northeast Regional Futsal Championship, hosted by the Massachusetts Futsal Association from Jan. 13-16.

Select Tournament: *

Gender: *

Age group: *

Registration available ONLY in the following age groups: B13, B14, B16, G16. Registrations for other age groups/brackets are wait list only.

Team name: *

Club/town affiliation: *

Team Colors: *

What is the most recent soccer league your team played in:

Soccer season division:

Soccer season record:

What is the most recent futsal league your team played in:

Futsal division:

Futsal record:

Tell us about your team: *

Head coach first name: *

Head coach last name: *

Head coach email: *

Head coach mobile #: *

Head coach address: *

Head coach city: *

Head coach state: *

Assistant coach first name:

Assistant coach last name:

Assistant coach email:

Assistant coach mobile #:

Team manager first name: *

Team manager last name: *

Manager email: *

Manager mobile #: *

You have two payment options: credit card or check.

Please make your check payable to "Massachusetts Futsal Association" and mail to:

Massachusetts Futsal Association
849 Boston Post Rd. #8F
Marlborough, MA 01752-3756

Checks must be in the full amount of your registration and must include any additional player fees. Please print the age group and name of the team in the memo line and be sure a phone number is on the check.

Credit card transactions occur on the second part of our registration, via the US Youth Futsal site. There is a fee of $15/team for the credit card processing.

Registration is not complete until payment is complete.

I am submitting payment in the amount of: * $

Remember to add $8/player for any players not registered with a US Youth Futsal program for 2012.

After you click submit below, you will be redirected to the US Youth Futsal web site, where you must register your team and players for insurance purposes. Further instructions and information will be provided. Teams currently participating in US Youth Futsal leagues, please use your existing login.

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