New Member REGISTRATION FORM

Player’s Name:_______________________________Cell:___________________________

D.O.B______________________

Player E-mail ___________________________________________________

Father’s Name: ______________________Cell:___________________________

Father’s E-mail__________________________________________________

Mother’s Name: _____________________ Cell:___________________________

Mother’s E-mail__________________________________________________

AUTOMATIC PAYMENT INFORMATION

Please fill out all information for our Automatic Credit Card Payment Process.  This action is REQUIRED for all clients on a MONTHLY billing cycle.

Full Name on Card_____________________________________________________

Credit Card Number____________________________________________________

Card Type ________________________________

Expiration Date ____________________________

CVC Code ________________________________

Billing Zip Code____________________________

Membership Package________________________

Cost_______________________________________

*By providing your credit card information, you agree to the terms of the membership