Name of Participant: *

Name of Parent (if under 18yrs old):

Date of Birth *

Age Group *

Gender: *

Male
Female

Position that you play in:

Club or Academy that you are currently playing with?

T-shirt size

Any Medical Illness? *

No
Yes

If yes, please state the illness:

Email: *

Telephone Number: *

Payment:

Bank Transfer
Cash
Check

Comment:

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