PA vs.
@
Send this form
with check payable to: Bill Gaffey c/o PA/MD Camps,
(717) 903-0732
Tourney Fee is $175.00 – 3 games guaranteed Top Teams advance to medal round play
Association___________________________________________________ Contact Person __________________________
Head Coach ______________________________ Team Name_______________________________________
Age/Grade Division_____________
Coach’s Address_____________________________________________________________________________________________
STREET ADDRESS OR P.O. BOX
CITY
STATE ZIP
Coach’s Home Phone (_____) _________________ Work Phone (_____) _________________ Fax (______) _________________
PRINT OR TYPE LEAGUE ROSTER FORM LEGIBLY. RETURN
ALL COPIES OF THIS FORM TO PA/MD CAMPS
NAME
ADDRESS
AGE BIRTH
SEX
(First,
Last, Middle Initial) (Street, City,
State, Zip) NOW
DATE
1.
2
3
4
5
6
7
8
9
10
11
12
13
By my signature, I hereby
certify the above information is complete and accurate to the best of my
knowledge & that I have seen an original of all birth certificates.
Signature______________________________________________ Date________________________