No Value Purchase
| REGISTRATION INFORMATION | |
| First Name: | Dan |
| Last Name: | BA-test |
| Email Address: | dan@libertyconcepts.com |
| Street Address: | 1 Test. St. |
| Address Line 2: | Apt. 0 |
| City: | Boston |
| State: | MA |
| Zip Code: | 02134 |
| Phone: | 555-555-5555 |
| MEMBERSHIP PACKAGE OPTIONS | |
| Basic Membership ($10): | 1 |
| Team Captain Membership ($20): | 2 |
| Team All-Star Membership ($40): | 3 |
| Hall-of-Fame Membership ($50): | 4 |
| T-Shirt ($20): | 1 | T-Shirt Size Selection: sml: 1 med: 2 lrg: 3 xl: 4 xxl: xxxl: |
| Scarf ($20): | 1 |
| SSUSA Red Bracelet ($5): | 1 |
| Donation Amount ($): | |
Enter your order total below and click the Google Checkout button to complete purchase.
Alternatively, you can mail a check or money order to: Street Soccer NYC, 5 Hanover Square, NY, NY 10004
Please print this page and include it with your check. Your order will processed when your check is received.
*Does your company match charitable donations? If so, please consider initiating a matching gift from your employer.
Paid for by Street Soccer USA
+ Power and Design from Boston + Liberty Concepts +