2025 Application for Rep Division Appeal

Form to be completed

Fields marked with an * are required.

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APPELLANT INFORMATION

Name

First Name

Last Name

Phone Number

Cell Phone Number

PLAYER INFORMATION

Name

First Name

Last Name

Current Address (Proof of residency may be required)

Street Address

City

Country

Date of Birth

Team played with in previous year:

APPELLANT REPRESENTATIVE (If different from Appellant)

Name

First Name

Last Name

Phone

AFFILIATED ASSOCIATION INFORMATION

LOCAL ASSOCIATION INFORMATION

Name of Association

Please do not use acronyms (e.g. GMBA, WMBA etc.)

NATURE OF APPEAL

NATURE OF APPEAL (Check one)

Local Association Release Affiliate Association Release Both Local Association and Affiliate Association Release Other

If Other was selected, please describe:

Describe the reason for the appeal:

Please list any dates that you are not available in the next 30 days:

Supporting Documentation

Local Association Release Decision

Affiliate Association Appeal Decision

Additional Supporting Documentation Provided

Payment

Discount

Subtotal

Tax

Total USD