Boys 120 lGirls 120 lCo-ed

Internal Use 0n
192 East Bay Street, Suite 301
Charleston, SC 29401
Email:
Fu: [843)
Program ad / regis packet:
Logo on Web site:
614-4746
Attendee List:
TOURNAMENT HOSTING APPTICATION
Please download this application template, input the required information and e-mail it to tournament@usclubsoccgJ,Org. Your tournament
will be considered unrestricted - that is, open to all U.S. Soccer-affiliated members - unless you specifically request otherwise. You may also
print and fax the application, but e-mail is strongly preferred. Please refer to "Tournament Rules and Sanctioning" (Policy Section 7), which can
be found at usclubsoccer.org. Upon signing this application you agree to the conditions of the Tournament Hosting Agreement Terms on page 2.
GENERAL INFORMATION:
1. Name of
Tournament:
2. Host Ciub Member:
3. Tournament Dates:
5. Venue Owner Name
and Address:
6. Tournament Director:
Royal Rumble
Razor City Reneqades
Jan 11-12
4. Venue[sJ:
CCPRD R.ec Center
2414
Campbell County Parks & Recreation
P.O. Box 3033 Gillette, Wyornins 82717
Telephone-Main:
Tohv Westbrook
307-660-9365
TelephoneAlternate:
Address:
City, State and Zip Code:
To bv.Westb rook(Orupxe
E-mail:
n
erq y. co m
Fax:
T.Disciplinary Committee
Chairman:
Brian Timmons
Address
City, State and Zip Code:
3300 Fitzpatrick Dr
Gillette, WY 82718
307-660-7648
Telephone-Main;
TelephoneAlternate:
timrnons330tDomail.com
E-mail:
Fax:
COMPETITION INFORMATION:
B.
Type oftournament:
ffi
Unrestricted
Restricted
n
Unrestfic-ted: Apen to afjiliated teams from US Club Soccer, other U.S. Soccer-affiliated members and from other countries (upon
Restricted: Restricted to teams registered throuoh US CIub Soccer.
9. ls the tournament being sanctioned by another U.S. Soccer affiliate?
10. Estimated number of teams:
Boys
| Ves
120
fl No X
lGirls
I
U.S.
Soccer approval).
If yes, which affiliatefs)?
120
11. Team entry deadline:
December 2:9.2413
12. Number of international teams***
0
13. States of anticipated attending teams:
WY, SD, MT
14. Team age groups:
u8-u19
15. Team size for each age group [3v3, 4v4, etc.):
16. Number ofguest players/team from outside clubs:
5v5
26 (USYS) teams
17. Source of referees:
Area
lCo-ed
18. U.S. Soccer-certified referee assignor:
certified referees
Brent Knottnerus
19. Referee assignor phone number [indicate if work or home numberJ:
307-299-6295
14
USSF
Note that in all US Club Soccer-sanctioned competitions, players will be permitted to play up in age group within the same club. No US Club
will be required to obtain travel permissions to participate.
Soccer teams
Any tournament involving international teams must also obtain permission from U.S, Soccer. The required U.S. Soccer form can be
obtained from US Club Soccer on the Club Resources page in the members-only section of usclubsoccer.org. The additional USSF form, a
copy ofthe tournament rules and a $75 check made out to U.S. Soccer should be sent to US Club Soccer's Charleston, S.C., office at the
address above along with this form for approval. After US Club Soccer approval, we will forward the form, a copy of the tournament rules
and the $75 checkto U.S. Soccer.
Signature of President or Chief Officer of Host Club
Date:
APPROVAL
DENIAL
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