2008 Jr. Fan Club Registration



Contact Information

Child's Name:

Sex:

Parent Name:

Address:

City:

Postal Code:

Phone Number:

Email:

 

Member Information

Age:

Date of Birth:

T-Shirt size:

Do you play lacrosse?

What team and association?

 

Payment Information

Membership will cost you...

$10.00
 

I wish to pay...

 
 

I hereby certify that the above information is correct.

 
 
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