Fort Wayne Fusion Player Registration Form
$50 non-refundable deposit is required to finalize registration. Checks can be mailed to: Fort Wayne Fusion, 11536 Grabill Road, Leo, IN 46765
Player Information
Last Name *
Your answer
First Name *
Your answer
Gender *
Birth Date *
MM
/
DD
/
YYYY
Is this your senior season? *
Street Address *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
Player's Cell # (xxx-xxx-xxxx)
Your answer
Player's Email
Your answer
Soccer Experience
Your answer
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