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REGISTRATION FOR THE 2009 SEASON WILL BEGIN 11/1/2008

Player's Name

First Name

Last Name

Date of Birth
Grade
Parent's Name

First Name

Last Name

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

CellPhone

Home Phone

E-mail
Emergency Contact

First Name

Last Name

Cell Phone
Insurance

Company Name
Group Insurance No.

Group Number
Insurance Policy

Policy Number
Experience
Position
Volunteer
Comments

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Revised: 07/21/08