2023 Region 12 AYSO EXTRA Interest
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Player First Name *
Player Last Name *
Player Gender *
Player Birth Year *
Parent First Name *
Parent Last Name *
Parent email address
I have read the information provided in the accompanying email and I understand the components of Region 12's potential EXTRA program including tryouts, travel, year long time commitment, coaches, referees, and cost.  Please direct all questions to Matthew Skoll Regional Commissioner, Region 12. matthew577@gmail.com *
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