Personal Information
First Name:
Last Name:
Address:
 
City, State, Zip:
,
Home Phone:
Work Phone:
Email:
   
Group Type:
Group Name:
   
We will compete in:
 BasketBall
Dodgeball
Kickball
   
  Please list any Adults who are willing to Referee:
 

Payments
Qty
Description
Chapter Team Fee
(Same fee required if participating in 1, 2 or all 3 sports)
$110.00 each ($120.00 each after May 5, 2008)
Number of Additional Dodgeball Teams
$35.00 each ($45.00 each after May 5,2008)
Number of Individual Registrants
$20.00 each ($25.00 each after May 5, 2008)

 

Payment Info
Pay by Check:
Card Type:
Card Number:
Card Holder Name:
Expiration Date:

Team Roster
First Name
Last Name
Team Number
Prospect