Please fill out the following form and we will contact you as soon as possible.

Thanks for expressing interest in our club.

 

First Name:  Last Name:
Address: City:
State: Zip Code:
       

Phone Numbers / Contact Information
Home: Work:
Cell: Email Address:
       
Date of Birth: Age:  
       
       

      

Soccer Background

Highest Level of Soccer/Football You've Played?

Professional

Semi-Pro

Amateur

College/School
   
When (Year):  Where/Team: 
 

 

My Preferred Position:

Goalkeeper  Defender  Midfielder  Forward

 

I am in Fit / In Good Shape

Yes

No, but will take weeks to get in shape.

 

I am interested in: (Choose all that apply)

LASC 1st Team

Womens / Girls Team

LASC Over 30

LASC Over 40

Non Competitive