Grassroots Symposium - St. Paul, MN

September 29th - October 1st, 2023

First Name: *

Last Name: *

Pronouns:

Email Address: *

Phone number: *

Birthdate (MM/DD/YYYY):

Please identify your affiliation below: *

Organization Affiliation: *

Title/Position: *

Ethnicity: *

Gender: *

Which of the following best describes the organization you are affiliated with? *

Which term best describes the income level of the community your organization serves? *

Majority High-Income

Majority Middle-Income

Majority Low-Income

How many young people does your organization serve on an annual basis? *

Did you ever attend the Urban Soccer Symposium, hosted by the US Soccer Foundation? *

Yes

No

If Yes, how many times? If no, write N/A. *

How did you learn about the Grassroots Symposium? *

We strive to host inclusive, accessible events that enable all individuals, including individuals with disabilities, to engage fully. As such, please let us know what accommodations we can provide to help all attendees engage fully: *

Do you have any food allergies? *

Yes

No

If yes, please list.

Are you interested in attending the Evening Reception on Friday, September 29th at 6:00PM? *

Yes

No

Are you interested in attending the MN United game vs San Jose on Saturday, September 30th at 7:30PM? *

Yes

No

I hereby grant a license to US Youth Soccer, and their agents, including any advertising agencies, to use and to license others to use my name, recorded voice, image picture or likeness in any live or recorded audio, video or photographic display or other transmission for purposes of promotion an duplicity in connection with the Grassroots Symposium and any future US Youth Soccer events or programs and hereby waive any rights of compensation or ownership thereto.

I have read and I understand this model release and authorization to video/photograph. *

I Accept

I Do Not Accept

Hotel Information

US Youth Soccer has secured a special group rate of $124/night at the event venue, the Intercontinental St. Paul Riverfront.

Rooms are now on a request basis as there is limited availability at the hotel. To inquire about a room, please email Zach Legleiter at zlegleiter@usyouthsoccer.org with your name, requested check in date and requested check out date. Thank you!

Payment Options

$150.00 per person

Please indicate how many registrations you are purchasing below. (if more than 10, please reach out to Jess Nance at jessie.nance@gmail.com.) *

If you are paying for more than one registration, please list the names of those you are covering. Click the Green plus sign to enter more names.

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If your registration was paid for, please let us know who it was paid by.

PLEASE NOTE: There will be a 3% processing fee added to your credit card payment.

To pay by check, please submit no later than 30 days after registering, but no later than September 1st, 2023, to the below address:

US Youth Soccer Association

9220 World Cup Way

Frisco, Texas 75033

Memo: Grassroots Symposium