** Applications filled out online can be paid with a CREDIT CARD or by mailing a check.


  already applied?   click here to make payment only 


Brevard Fall Challenge

Brevard County Area, Florida, USA

Do NOT hit the ENTER key !   Use the TAB key to move around. When you are finished, select SUBMIT at the bottom

* information that must be filled out online


What is the Age Division of your team? *  


                    Boys or Girls Team?         *  


     Please enter your TEAM NAME::   *  


Enter your TEAM CODE in the space provided below.

  example B5SCU9798FC2 (no dashes)

Enter your CLUB AFFILIATION in the space provided below.

Enter your STATE ASSOCIATION in the space provided below.

Enter your GOTSOCCER ID#



Please provide the following COACH information:

Coach FIRST name*

Coach LAST name*


Street Address



Zip/Postal Code

Home Phone

Cell Phone*

Please provide the following ASSISTANT COACH  information:

Assistant First Name

Assistant Last Name


Street Address



Zip/Postal Code

Home Phone

Cell Phone

Please provide the following CONTACT information:

This person will receive all communication - and must have an email address

Contact First Name*

    (someone other than a coach)

Contact Last Name*


Street Address*



Zip/Postal Code*

Work Phone

Home Phone

Cell Phone*

Uniform COLORS:      primary jersey                alternate jersey


HOTEL Name  


According to the list below, enter the best estimate of your team's NUMERICAL RATING:


Comments: Please provide any additional information to help us evaluate your Team's strength (ex: state or regional cup team, tournament record, etc.)


 LEVEL choose one*  


 *    I  will be responsible for staying current on tournament information by checking email and visiting the web site regularly.


When you click on "Submit Form" below, your application will be submitted,

then on the next page you can begin the payment section by credit card or mail

These are 2 separate processes.


Please only click ONCE on Submit  - it could take a few seconds.  



Author information goes here.
Copyright 1999 [OrganizationName]. All rights reserved.
Revised: September 07, 2012