EmailMe Form - ONLINE REGISTRATION FORM

Field hockey showcase (women, age 13 and up) Sunday June 10, 2012, The Hague, The Netherlands - Registration fee 150 euros

Important Notes
• UStudy will process your registration and send the confirmation to you within 5 business days by e-mail. If you do not receive the confirmation within that time, please send a copy of your registration by email to info@ustudy.nl to avoid delays.

• Cancellation policy: UStudy maintains the right to cancel the Showcase in the event of insufficient participation or due to other unforeseen circumstances. Should this occur, all registrants will be refunded their registration fee in full. In case of cancellation on the part of the participant - for whatever reason - there will be no refund.

• Personal data policy: during the event videotapes will be made with the objective of evaluating the skills of each participant. These tapes will remain the property of UStudy and will be distributed to the participant, US coaches and scouts. After the Showcase, each participant will also be sent a skills evaluation summary via e-mail.

• Participants not abiding by the rules, regulations and policies established by UStudy are subject to dismissal without reimbursement or recourse

• The participant hereby waives and releases UStudy and the UStudy event sites from any and all liability for any injury or illnesses while participating in the event.

• The participant hereby authorizes the director of UStudy and all event sites to act according to their best judgment in any emergency if the participant cannot be contacted.

• The participant understands that each participant is required to have his/her own medical and accident insurance.

• This registration form requests information about your Showcase participation as well as information about your personal and educational background for the Showcase information packet to be distributed to all interested American coaches and scouts. You will not be able to submit the form without all the required information. By submitting the form you agree with all the conditions mentioned above.

ONLINE REGISTRATION FORM PARTICIPATION GO USA SHOWCASES
Field hockey showcase (women, age 13 and up) Sunday June 10, 2012, The Hague, The Netherlands - Registration fee 150 euros Important Notes • UStudy will process your registration and send the confirmation to you within 5 business days by e-mail. If you do not receive the confirmation within that time, please send a copy of your registration by email to info@ustudy.nl to avoid delays. • Cancellation policy: UStudy maintains the right to cancel the Showcase in the event of insufficient participation or due to other unforeseen circumstances. Should this occur, all registrants will be refunded their registration fee in full. In case of cancellation on the part of the participant - for whatever reason - there will be no refund. • Personal data policy: during the event videotapes will be made with the objective of evaluating the skills of each participant. These tapes will remain the property of UStudy and will be distributed to the participant, US coaches and scouts. After the Showcase, each participant will also be sent a skills evaluation summary via e-mail. • Participants not abiding by the rules, regulations and policies established by UStudy are subject to dismissal without reimbursement or recourse • The participant hereby waives and releases UStudy and the UStudy event sites from any and all liability for any injury or illnesses while participating in the event. • The participant hereby authorizes the director of UStudy and all event sites to act according to their best judgment in any emergency if the participant cannot be contacted. • The participant understands that each participant is required to have his/her own medical and accident insurance. • This registration form requests information about your Showcase participation as well as information about your personal and educational background for the Showcase information packet to be distributed to all interested American coaches and scouts. You will not be able to submit the form without all the required information. By submitting the form you agree with all the conditions mentioned above.
Showcase of your choice	Field hockey
First Name *
Last Name (as in your Passport) *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Email participant *
Email parent/legal custodian *
Home Phone (country code/area code/phone number) *
Cell phone (country code/area code/phone number) *
Height in feet and inches *
Weight in US lbs *
Jersey size (S/M/L/XL/XXL) *
Current athletic club *
Name and email address current coach *
Educational information
Current or last educational institution attended (Name, location, country, level and name diploma if any) *
Grade Point Average (on your country’s scale) *
TOEFL/IELTS score, if any (scores + date taken)
SAT or ACT score, if any (scores + date taken)
Interested in attending High School in the US? *	Yes No
Interested in attending College in the US? *	Yes No
Open to attending a religious school in the US? *	Yes No
Amount of own funding available for first year of study US$ *
Looking for financial aid/scholarship *	Yes No
Available term for entry at US school (Fall/Spring term and Year, e.g. Fall 2012) *
YouTube link with game or skill video (if any)
How/from whom did you learn about this showcase? *
Please provide a short description of your study and athletic aspirations in the US (limit of 100 words): *
Payment information Payment instructions, if residing outside the Netherlands: Will deposit the registration fee within 5 business days of submitting this registration form to International Bank Account Number NL32ABNA0567380726 at ABNAMRO Bank in Voorburg, the Netherlands, BIC/SWIFT code ABNANL2A in name of UStudy in Voorburg. Note: wire fee to be paid by the registrant. Please mention the title and city of the event as your reference. Once the payment is received UStudy will send a registration confirmation by email within 5 business days. Payment instructions, if residing in the Netherlands: I hereby authorize UStudy to charge my account in the Netherlands for the registration fee indicated above for the showcase I register for. The fee will be charged to the account below about at least two weeks before the showcase date.
Bank account number (in the Netherlands)
Name of account holder
As agreed by participant or parent/legal custodian (if minor) (please type initials) *
City and date *

Educational information

Payment information