AYSO Region 143 Registration Cancellation Form

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Please complete this form once for each player that you want to cancel from a program during the Fall 2023 -Summer 2024 program (MY2023 Membership Year).

Please reference our website for drop/refund dates and policies.

As a reminder, the $20 Player Membership fee is non-refundable, but will cover your player for any AYSO programs through the membership year running August 1, 2023 - July 31, 2024.

Email *

Account Last Name *

Account First Name *

Player Last Name *

Player First Name *

Player Date of Birth *

YYYY

Player Division *

Mailing Address - Street Address *

Mailing Address - City *

Mailing Address - Zip Code *

Reason for drop *

If you're due a refund... *

Refunds are made back to the credit/debit card used for the original transaction*.

Alternatively, you may select REGION 143 CREDIT below (the amount of the refund will stay on your Region 143 account and be used towards your next registration order).

*IN SOME CASES, when we are unable to credit back your card, we will either mail a check or refund by Zelle (select one as an back up option below).

A copy of your responses will be emailed to the address you provided.

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