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Online Registration (if you register online you do not need to complete a printed registration form)

You Are Registering for:
Junior Premier Winter 2010

*First Name  
*Last Name  
*Address  
*City  
*State  
*Zip  
*School  
*Grade  
*Graduation Year  
*Date of Birth  
*Height  
*Hand   Right-handed   Left-handed
*Mother's First Name  
*Mother's Last Name  
*Father's First Name  
*Father's Last Name  
*Home Phone  
Player Cell Phone  
Mother's Cell Phone  
Father's Cell Phone  
Player's Email   @
*Mother's Email   @
*Father's Email   @
*What positions does player play?   OH  MH  S  DS  No Preference  Beginner
   
Emergency Contact During Camp    
*Contact Name  
* Emergency Contact Phone  
*Relationship to Player  
Any injuries, allergies, or medical issues in general that the club should be initially aware of during tryouts  
Any Notes for Premier Staff  
*Method of Payment
You may make payment online via PayPal or you may send in a check. There will be a PayPal Buy Now button displayed on the confirmation screen after you have submitted this registration.
 		  

I will be sending a check
I will be paying online
      Name on Credit card will be