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Western New York Flash
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WNY Flash Prospective Player Form
Prospective Player Information Form
If you are interested in playing for the WNY Flash, please complete the following form.
The Flash will host open tryouts at Sahlen's Sport Park on February 17th and 18th.
All prospective players must be at least 18 years old by March 1, 2012 to be eligible. The cost before January 22nd is $99 (the cost after is $120).
Attending Tryout
Yes
No
Playing Overseas
*
Last Name
*
First Name
*
D.O.B (DD/MM/YYYY)
*
Health Insurance
Yes
No
*
Phone (Please enter without dashes: xxxxxxxxxx)
*
Email
*
Emergency Contact Name
*
Emergency Contact Phone (Please enter without dashes xxxxxxxxxx)
*
Contact's Relationship to Player
*
Position
Forward
Left Midfielder
Right Midfielder
Attacking Midfielder
Holding Midfielder
Right Back
Left Back
Centerback
Goalkeeper
*
Second Position
Forward
Left Midfielder
Right Midfielder
Attacking Midfielder
Holding Midfielder
Right Back
Left Back
Centerback
Goalkeeper
*
College/University attended
*
Soccer Achievements
*
Describe yourself as a player
*
T-Shirt size
S
M
L
XL
*
Payment made by
*
The "Payment made by" field is the name we will associate with the payment made through PayPal.
NOTE: Once you click the "Submit" button, you will be required to complete online payment via PayPal.