NYSRA Membership Form for 2024

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By filling out this form you also agree to the following:

1. I have no physical illness or impairment which will make participation in soccer related activities dangerous to me.
2. I agree to abide by the NYSRA Code of Conduct and its Bylaws.
3. I will remain in good standing and follow the procedures, guidelines and protocols of the US Soccer Federation.
4. I understand that membership does not guarantee receipt of any assignments.
5. I understand that membership does not create an employment contract or an employment relationship with the NYSRA.
6. I agree to pay any dues, fees and fines to keep my membership in good standing
7. I attest that the information submitted in this form shall be true and correct, and that I have not lied about, misrepresented or otherwise falsified any information in this form.

Email *

First Name *

Last Name *

Address *

(including unit/apt number)

City *

State *

(2 letters only)

Other:

Zip Code *

Cell Phone Number *

(numbers only)

Alternate Phone Number

(if available)

Date of Birth *

YYYY

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