Application for Initial (New) Affiliation

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Application for Initial (New) Affiliation

This form must be completed and submitted with all required documentation to the FYSA State Office. Please find the updated criteria necessary to become an affiliate here.

Name of Organization *

Contact Person (Agent of Record) *

Email Address *

Mailing Address *

City *

State *

Zip Code *

Phone *

Fax *

Primary Field Name *

Primary Field Address *

Zip Code *

City *

State *

Items below must accompany application:

Fee: $1500 total: $135 affiliation fee, $1365 prepaid registration. New Member Affiliation fees can be submitted here: https://www.gotsport.com/forms/open/?FormID=3042
(Please contact Michelle Cook at finance@fysa.com at the FYSA state office if you have any questions about submitting the appropriate fees.)
List of Board of Directors including USSF Registered Referee Assignor
Written proof of playing field availability & declaration of home field.
Written letter from the local District Referee Administrator indicating sufficient referees to service your club.
Written letter or email from the League in which you club will be scheduled.
A copy of the organization's bylaws, rules and/or regulations.
Name of certified assignor.
Any supporting material from the New Member Entry Criteria should go here.

Please upload the necessary documents via the boxes listed below.

(The only acceptable file formats to upload are Word/PDF.)

File Upload

We agree by application to follow all of Bylaws, Rules and Regulations of Florida Youth Soccer Association, US Youth Soccer, and the United States Soccer Federation now in effect, as well as all of those that may be enacted in the future.

Name *

Date *

By checking this box, I hereby certify that the above information is accurate and I have the authorization to submit this material on behalf of my organization.

Once this Application has been approved by FYSA’s BOD, the above named Agent of Record may obtain an online user name and password to complete a current affiliation form listing additional agents for the affiliate and other necessary information.