Please provide the following information as completely as possible:
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 USSF ID Number (if available) 
 

      Enter South Carolina Information Below     

                First Name 
               Middle Name 
                 Last Name 
           Street Address1 
           Street Address2 
                      City 
                     State 
           Zip/Postal Code  - 
           Gender (M or F)  Male     Female
                Referee Grade      ChooseGrade 9Grade 8Grade 7Grade 6Grade 5Other 
Date of Birth (mm/dd/yyyy) 
                Cell Phone 
                Home Phone 
            E-mail Address 

 If you have a conflict, please explain briefly - 
ie - your son or daughter plays for a particular team in the tournament
 

November 10, 11, 2007         Yes     No
December 8, 9, 2007        Yes     No

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