REGION STATUS CHANGE REPORT
The law is very specific regarding the fiduciary responsibility of non-profit corporations and their Executive Members. When it is contemplated that
the status of a Region should be changed, there are certain procedures that must be followed with respect to determining the reason for the change
and in identifying and securing the assets of AYSO. The purpose of this form is to provide the National Board of Directors with the details necessary
to properly determine the status of a Region and to ensure the action taken is appropriate to the circumstances.
THIS FORM IS TO BE COMPLETED BY THE AREA DIRECTOR OR SECTION DIRECTOR.
BOTH THE AREA DIRECTOR AND SECTION DIRECTOR MUST SIGN THE FORM.
Mail or FAX completed form to:
AYSO National Office, 19750 S. Vermont Ave, Suite 200., Torrance, CA 90502 FAX 310-525-1155
Notify the the Member Services Department of this action by calling 800-872-2976 X7962
Section: Area: Region:
CURRENT STATUS: PILOT REGION CHARTER REGION
SUSPENDED PILOT REGION REVOKED PILOT REGION SUSPENDED CHARTER REGION REVOKED CHARTER REGION
CHANGE THIS REGION’S STATUS TO:
Today's Date: Pilot Date: Charter Date:
Registered Players (current year)
Registered Players (last year)
Registered Volunteers (current year)
Region Name/Community: State:
Reason for this action:
Who informed you? (Name & position)
Date Section Director was notified: By whom:
Date National Office was notified:
Name of person at National
Office who was notifed:
Have bank accounts been closed? YES NO
If yes,
by whom?
Was a check forwarded to the National Office? YES NO If no, where was the check sent?
Money owed to AYSO: Money owed to any vendor or service provider: Money in the bank (if known):
Region equipment and other assets acquired while this Region was with AYSO remain the property of AYSO.
Attach a list of any known equipment and other assets. Below, provide contact information for a person who knows the location of such property.
Name Street Address
City State Zip Code Area Code Home Telephone
Additional comments; including any plans for re-starting the region:
Section Director:
Area Director:
Signature: ____________________________________________ Date ___________________ Signature: ____________________________________________ Date ___________________
For office use only: National Secretary: Approval Date:
Account Closed by: Closure Date:
Rev. 12-11
6 MONTHS 12 MONTHS 18 MONTHS OTHER: __________________________________________
EXTEND THIS PILOT REGION’S STATUS:
