Valley Ultimate U20 Fall League 2017 Registration
First Name *
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Last Name *
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Your email address *
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Re-enter your email address *
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Cell phone number *
Write 'none' if you don't have one
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Home Phone Number *
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What email address did you use to pay your $70 registration fee? *
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Full name of the person who paid your registration fee *
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Street address *
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City *
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Zip *
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State *
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Gender *
Date of Birth *
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Grade *
School *
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Do you understand that you must bring a completed medical authorization form to the first practice? *
List 'Joe Costello' as the chaperone. Find the form here: http://www.usaultimate.org/assets/1/Page/Medical%20Authorization-V4.1.form.pdf
Please give us your parent/guardians complete contact information *
Full names, email addresses, cell phone numbers, mailing addresses. You must list at least one.
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How will you be paying the registration fee? *
You can use a credit card with PayPal. You don't have to sign up with PayPal to use PayPal.
USAU membership status: *
USAU ID Number *
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Do you understand that your registration is NOT confirmed until your payment has been received and acknowledged. *
Please check ALL of the events that you WILL be able to attend. Practice/Games are from 1:00 to 3:30. *
Required
I am interested in playing for the Valley Ultimate Youth Regionals team in Pennsylvania on the weekend of 10/6-10/8. (We will send out additional info to players who select "Yes" here.) *
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Please indicate your preferred T-shirt/jersey size. *
Is there anything else that you think we should know?
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