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
MM
/
DD
/
YYYY
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.
Your answer
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
Your answer
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.)
Required
Please indicate your preferred T-shirt/jersey size.
Is there anything else that you think we should know?
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