Required fields are marked with an asterisk *
|
First Name: |
*
|
Middle Name: |
|
Last/Family Name: |
* |
NickName: |
|
Address: |
* |
City: |
* |
Postcode: |
|
Country: |
* |
Type of Identification: |
* |
Enter Passport or National ID or Birth Certificate No: |
|
Marital Status: |
* |
E-mail: |
* |
Mobile Phone: |
*
e.g. 415-555-1212 |
Other Phone: |
|
Skype ID: |
|
Languages: |
* |
Languages 2: |
|
Date of Birth: |
* |
Height (cm): |
* |
Weight (kg): |
* |
|
Preferred Position: |
* |
Position 2: |
|
Position 3: |
|
Position 4: |
|
Foot Ability: |
* |
Nationality: |
* |
EU-Passport: |
* |
Contract Expiration: |
* |
|
Current/Last Club Name: |
* |
|
From: To: |
Country: |
|
Matches played: |
|
Goals Scored: |
|
League Category: |
|
Name of League: |
|
|
Previous Club Name: |
|
|
From: To: |
Country: |
|
Matches played: |
|
Goals Scored: |
|
League Category: |
|
Name of League: |
|
|
Other Previous Club Details: (In the above order)
|
Achievements:
|
Other Information:
|
|
Do you have video? |
|
Video Link: |
|
I am already represented by an agent: |
* |
Type of agent agreement: |
* |
Name of agent: |
|
Country of agent: |
|
I want to become a PatroDaniels Player |
|
Type of PatroDaniels Representation |
|
If only limited representation intended, give reasons here:
|
|
|