Personal Information:

First Name: Last Name:

Address:

City: State: Zip:

Country:

Tel: Email:

DOB: / / Sex: M F

Citizenship:

Playing Experience:

Current Club:

Previous Club:

Previous Club:

Current League:

Player Status: Please Check One

Pro Amateur College Youth

Position:

Special Awards:

Personal Playing Goals:

Do you wish to use FARA to help you to become a professional soccer player? YES NO

Do you wish to use FARA to help you find a team to play for in a foreign country? YES NO

Are you a professional seeking representation from a FIFA licensed Player's Agent? YES NO

Are you interested in becoming a signed player with a foreign club? YES NO

Are you interested in FARA's assistance in arranging a player trial or training excursion? YES NO

Are you interested in representation and/or assistance with: Foreign Clubs Domestic Clubs Both

For how long would you be willing to play in a foreign country? <6 months 6 mo- 1 year > 1 year

What countries in particular would you be interested in playing in?

What is your specific interest in FARA?

Please attach your soccer CV through email.