Annual Leadership Report

New Simplified Version as of 10/14/2020

In order to help simplify the use of this reporting form we have made the following changes:

* Only need to enter information for Executive Officers, Registrar, Risk Manager, Director of Soccer Developement and COVID-19 Safety Officer.

* No longer need to enter information for all other Directors.

Member Organization

Exact name of member organization *

Type of Business Entity *

Member organization website *

Location of Member Organization's Principal Office

No. and Street *

City *

State *

Zip Code *

Name and Contact Information for Executive Officers and Designated Directors 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
Director of Soccer Development (DSD)	Name	Address	Email Address	Phone Number
Organization's COVID-19 Safety Officer	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. *

I certify

I certify that the Member Organization shall comply with the Massachusetts Youth Soccer Constitution, By-laws and all applicable Policies and Guidelines as the same may be amended from time to time. *

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. *

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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