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EASTSIDE YOUTH SOCCER ASSOCIATION

PROTEST ( ) APPEAL ( )

PRINT THIS FORM AND COMPLETE WHEN FILING ORIGINAL PROTEST OR APPEAL (2 PGS)

RETURN TO: EYSA JUDICIAL

PMB 323 | 15600 NE 8th St., Suite B1 | Bellevue, WA 98008

DATE: _______________

PLAINTIFF

NAME: _____________________________________________________________

ADDRESS: _________________________________________________________

CITY, STATE, ZIP ____________________________________________________

TELEPHONE NUMBER _______________________________________________

Person or organization filing protest or appealing a decision:

AFFILIATION: Player ( ) Team ( ) Club ( ) (Check One)

League ( ) Coach ( ) State ( )

Region ( ) Other ( ) ________________________

Describe

If Filed By:

1. Player ________________________________________________________

2. Team _________________________________________________________

3. Coach ________________________________________________________

4. Name of Official in charge at your Club or League _________________________________________________

Street Address of your Club or League ________________________________________________________

City, State, Zip Code ________________________________________________________________________

Telephone Number with Area Code _____________________________________________

PROTEST OR APPEAL FILED AGAINST

Name of Organization/Individual _______________________________________________

Address __________________________________________________________

City, State, Zip _____________________________________________________

Telephone Number with Area Code ______________________________________________

AFFILIATION: Player ( ) Team ( ) Club ( ) (Check One)

League ( ) Coach ( ) State ( )

Region ( ) Other ( ) ________________________

Describe

THE FOLLOWING DATA IS REQUIRED (IF APPLICABLE)

1. Date of Game: _______________________________________________

2. Date of Incident: ______________________________________________

3. Type of Competition: __________________________________________

(League, State Cup, etc.)

4. Location: ____________________________________________________

DESCRIBE PROTEST OR APPEAL (Complete additional data on separate sheet if necessary.

Be sure to include names, addresses and phone numbers of any witnesses you cite in your protest/appeal.)

______________________________________________________________________________________