Michigan Youth Soccer League Affiliation Application Form
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1 Michigan Youth Soccer League
Affiliation Application
____ Spring
or
____Fall
Year: ______
____ Renewal Affiliation or ___ New Affiliation*
Affiliating Organization [Name of League, Association, Club]_______________________________________________________
Organization President:____________________________________________
Risk Management Number: ____________
Address:_________________________________________________________________________
Phone:_________________________________
Fax:_________________________
Email address: _________________________________________________________________
The undersigned acknowledges and affirms that he/she is a fully authorized official of the Affiliating Organization first named
above and hereby attests to its desire to be considered an affiliate of the Michigan Youth Soccer League (MYSL) and confirms
that it is in good standing with the MSYSA and the MYSL. Further, pursuant to the MYSL By-Laws, the undersigned, on
behalf of this Affiliating Organization, hereby confirms and acknowledges that it is now and will remain in compliance with
the MYSL Risk Management provision of the MYSL By-Laws, specifically Section III Paragraph J, which states: All Clubs/
Leagues and their respective teams affiliated with MYSL will adhere to the risk management provisions of the MYSL and the
USSF Affiliate League. The failure by any MYSL-affiliated team person(s) -- including all Club/League principals, board
members, coaches, managers, significant adults assisting the team, and trainers -- to promptly comply with MYSL risk
management provisions will cause their MYSL status to be changed to disqualified, will cause them to be subject to MYSL fines
and cause the immediate suspension of their MYSL-associated activities until a satisfactory remedy is verified and approved by
MYSL.
Authorized Signature of Affiliating Official: __________________________________
Date: _____________________
Title: _________________________________
[Please provide at least two of the following from your Organization]
1) MYSL Delegate: _________________________________________
Risk Management Number: ____________
Address: ______________________________________________
Phone: ___________________________________
City, State, Zip: _______________________________________________________________________________________
Email address: _______________________________________________________________________________________
2) Field Scheduler: ________________________________________
Risk Management Number: ____________
Address: ______________________________________________
Phone: ___________________________________
City, State, Zip: _______________________________________________________________________________________
Email address: _______________________________________________________________________________________
3) Certified Referee Assignor:_______________________________________
Risk Management Number: ____________
Address: ______________________________________________
Phone: ___________________________________
City, State, Zip: _______________________________________________________________________________________
Email address: _______________________________________________________________________________________
4) Director of Coaching::_______ ______________________________
Risk Management Number: ____________
Address: ______________________________________________
Phone: ___________________________________
City, State, Zip: _______________________________________________________________________________________
Email address: _______________________________________________________________________________________
Affiliating Organizations must complete this form and return it to the MYSL President at each Fall and Spring registration date.
Failure to comply will result in the forfeit of registration fees, disqualification of all teams for at least one season and the
Affiliating Organization will have to reapply for MYSL affiliation.
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