4151 S. 84th Street, Suite B
Omaha, NE 68127
www.nebraskastatesoccer.org
K.I.S PROGRAM
Keep it Simple
P: (402)596-1616
F: (402)596-0660
Player Pass Correction Form
Word Template: You can type in this form before printing out form, use the tab
key to move from field to field. This will give you a typed form to send.
Note! Correction Form is used for corrections on player registrations that may only be made at the State-level, such as: Player ID #, Player Name and/or Birth Date.
Mail to: NSSA 4151 S. 84th Street – Suite B, Omaha NE 68127
Fax: (402) 596-0660
Directions for Form – Type or Print Clearly – see Word Template above:
1.
2.
Fill in Club, Club ID, Current Player ID and fill in only the information that needs to be changed.
If changing name or birth date – we need a copy of the birth certificate or a USYS Approved Proof of Age document.
CLUB NAME:
CURRENT PLAYER ID
CLUB ID #
TEAM ID
Attach appropriate documentation.
FIRST NAME
LAST NAME
BIRTHDATE
PLAYER ID
DATE STAMP: