LCBA Super Bowl Square Fundraiser
Please complete one form for each player as needed. All squares can be included on one form. Once form is completed and received, payment link will be provided. We must receive payment for your Squares or they will not be included!
Email address *
Age Division *
Please identify what player division you're supporting
Player Name *
Name of the player you are supporting or just 'LCBA'
Parent/Guardian Name: *
Player's parent name or your name if you are making this purchase for yourself
Phone *
Provide a number we can contact you when one of your Squares wins
Number of Squares *
Enter the total quantity of Super Bowl squares you are providing
Provide your List of Square Names
List the Name & Quantities of each Square for that name as it will distributed on master board


Rajai Davis: 4
The Lindor Family: 1
Mr. Francona: 3

If you are buying only for yourself, enter your own name.

Square Names *
You can hit [RETURN] after each name or copy/paste your list below:
Payment *
How will you be paying for Squares?
IMPORTANT! After you SUBMIT - please click the link to Pay on the next screen to complete your payment!
A copy of your responses will be emailed to the address you provided.
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