Name of Organization:

_____________________________________________________

Address:

City:

_____________________________________________________

______________ State:_____________ Zip Code:_______

Team Name:

_____________________________________________________

Head Coach:

_____________________________________________________

Home Phone:

Work Phone:

Fax :

Email:

Assistant Coach(s):

 Grades (Circle)

(___)________________________________________________

(___)________________________________________________

(___)________________________________________________

 ____________________________________________________

 ____________________________________________________

_____________________________________________________

Boys -        3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th, 11th, 12th Challenge 

Series Members $225 Per Team  - $200 Two or more 

First Time Participants $250 Per Team -  $225 Two or more Teams