OFFICIAL: Western Mass Relics 2021 Player Registration Form
Dear Relic, thank you in advance for filling out your Registration Form online! It's easy...just fill in the info as usual, scrolling down as needed. Click or tap "next" when prompted, and "submit" when you're all done.

If you have any questions, please contact Ted Chmura at either ted@WesternMassRelics.org or 413-589-1965.

Email *
First Name *
Last Name *
Date of Birth *
Note to Android Phone/Tablet users: when you go to input your Birthday, tap the "2020" at the top to change the Year.
MM
/
DD
/
YYYY
Mobile/Cell Phone
For example: 4135551212
Home Phone
If this is the same as your Mobile/Cell - skip it
Street Address *
City *
If your City or Town is not on the list, use "Other" at the bottom and type your City or Town.
State *
Zip Code *
Division *
Gold - Ages 65 and up / Silver - Ages 50 to 65
Preferred Positions *
Required
Relics Support
Let us know if you're interested in learning more about possibly helping out in these areas. We'll follow up with you.
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