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Annual Leadership Report
Member Organization
Exact name of member organization
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Type of Business Entity
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Non- Profit Corporation
For Profit Corporation
Unincorporated Association
Limited Liability Company
Other
Member organization website
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Location of Member Organization's Principal Office
No. and Street
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City
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State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
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Name and Contact Information for All Officers of Member Organization
Name
Address
Email Address
Phone Number
President
Name
Address
Email Address
Phone Number
Vice President
Name
Address
Email Address
Phone Number
Treasurer
Name
Address
Email Address
Phone Number
Secretary/ Clerk
Name
Address
Email Address
Phone Number
Registrar
Name
Address
Email Address
Phone Number
CORI Submitter/Risk Manager
Name
Address
Email Address
Phone Number
Name and Contact Information for All Directors of Member Organization
Name
Address
Email Address
Phone Number
Director
Name
Address
Email Address
Phone Number
Director
Name
Address
Email Address
Phone Number
Director
Name
Address
Email Address
Phone Number
Director
Name
Address
Email Address
Phone Number
Director
Name
Address
Email Address
Phone Number
Director
Name
Address
Email Address
Phone Number
Director
Name
Address
Email Address
Phone Number
Director
Name
Address
Email Address
Phone Number
Director
Name
Address
Email Address
Phone Number
Director
Name
Address
Email Address
Phone Number
Director
Name
Address
Email Address
Phone Number
Director
Name
Address
Email Address
Phone Number
Certifications
By checking the boxes below and by submitting this Annual Leadership Report to Massachusetts Youth Soccer Association, Inc. I am certifying the following on behalf of the Member Organization named above.
I certify that I have the authority to submit this Annual Leadership Report on behalf of the Member Organization and to make the certifications herein.
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I certify
I certify that the Member Organization shall comply with the Massachusetts Youth Soccer Constitution, By-laws and Policies as the same may be amended from time to time.
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I certify
I certify that all of the players, coaches, managers, administrators and other volunteer adults have or will be submitted by the noted deadlines to Massachusetts Youth Soccer for this soccer year and have met or will meet all of the requirements of Massachusetts Youth Soccer with regard to affiliation, playing age, educational/training requirements and criminal background checks by noted deadlines.
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I certify
Signature
By signing my name below I intend to sign this Annual Leadership Report and my name as signed below shall act as my signature. PLEASE WRITE YOUR SIGNATURE BY CLICKING IN THE BOX BELOW WITH YOUR MOUSE, HOLD DOWN THE MOUSE BUTTON AND DRAW YOUR SIGNATURE
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