CDL Club Application

Club Name:

Name Technical Leader:

Email Address:

Technical Leader Coach License Technical Leader Coach License US Soccer - A-License US Soccer - B-License United Soccer Coaches - Premier Diploma

Name of Additional Staff Member Holding a US Soccer C-License or Higher:

Name of Referee Assignor:

E-Mail Address:

Name of Grass Roots Instructor (if none at this time leave blank):

Email Address:

As Technical Leader I agree to attend all Technical Advisory Panel Meetings As Technical Leader I agree to attend all Technical Advisory Panel Meetings Yes No