2017 Fall/Winter Season Registration
WELCOME TO MGVA! — To register, please complete and submit the form below.

PLEASE NOTE THERE ARE 3 SECTIONS — Your registration is complete when you hit "SUBMIT" at the end of Section 3.

• Section 1 = Contact Information
• Section 2 = Team Information
• Section 3 = Ways to Pay / Acknowledgement

Your spot will be confirmed after payment is received (see "Ways to Pay" in Section 3).

Full Name: *
Please enter your name in the following format: First Last
Your answer
Email Address: *
Your answer
Street Address:
Your answer
City, State, Zip:
Your answer
Phone Number: *
Please enter your phone number, including area code, in the following format: XXX-XXX-XXXX
Your answer
Mobile Phone Number:
If you are interested in receiving cancellation alerts via text, enter your smartphone number in the following format: XXX-XXX-XXXX. If it is the same as the Phone Number above, feel free to enter "SAME"
Your answer
Date of Birth:
MM
/
DD
/
YYYY
Emergency Contact Name: *
Please enter in the format: First Last
Your answer
Emergency Contact Phone Number: *
Please include the area code and enter in the following format: XXX-XXX-XXXX
Your answer
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