Sat & Sun August 22 & 23, 2003 8:00AM – 5:00PM

WHERE: To Be Announced – Participants will be contacted directly to confirm registration and location of session.

Friday Night 6:00-9:00pm @ TBA

Sat/Sun. 8:00 am – 5:00 pm @TBA

REGISTRATION: Limited to 25 people. Registration forms must be received by August 1, 2001. Tear off

and mail the completed form at the bottom of this page to:

Daniel Sherrin

11921 Juniette St., Culver City, CA. 90230

Fax to (310) 552-1219

ANY QUESTIONS CALL (310) 306-1373 or email dsherrin@topa-ins.com

Materials/Equipment Required: Bring notebook and pen for classroom instruction. Field instructions will require athletic apparel, tennis shoes or cleats, shorts, soccer ball and shin guards if desired for all three days. Please bring sunscreen, Lunch and water or drinks for Sat and Sun.

You MUST attend ALL 3 DAYS/ 19 Hours of the course to be certified. No split sessions are allowed.

Form must be signed by Regional Coach Administrator confirming successful completion of AYSO Intermediate Coaching Course.

REGISTRATION FORM

AREA P ADVANVCED COACHING CLINIC

NAME		PHONE		( )
	Print your name
ADDRESS
CITY			ZIP

REGION

#:________

Region Name:_____________________________________

Email:____________

Years of Coaching

Experience

Soccer Playing Experience: Amateur High School

College Professional None

Completed Safe Haven

Date: _________________

What level have you coached (Circle): U-8 U-10 U-12 U-14 U-16 League Tournament Allstar Boys Girls

The above named person has successfully completed the AYSO INTERMEDIATE COACHING COURSE

Regional Coach Administrator
	Print Name

	Signature