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Empire United MLS NEXT Boys Academy - Trial Request Form
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* Indicates required question
Name (Last Name, First Name)
*
Your answer
Birth Year
*
Choose
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Graduation Year
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2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Current Club
*
Your answer
Current School
*
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Current GPA
*
Your answer
Email Contacts
*
To list multiple emails please separate with a ";"
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Cell Phone Contact
*
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Parent/Guardian Name
*
Example: Parent Name-Relation; Parent Name2-Relation2
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Address
*
Full Address: Street, City, State, Zip
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Highlight Video/Match Video link
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