Tidal Wave Challenge Application: Welcome

Tidal Wave Challenge Registration

Team Name: _______________________Division: (circle) 9u 10u 11u 12u 13u 14u

Jersey#                      Name                                       Age/Grade/DOB

      
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Head Coach    _______________________________________________________
Address/City/State/Zip _______________________________________________
Phone                ___________________________________________________
Email Address       ___________________________________________________
Asst. Coach          __________________________________________________

Registration MUST BE RECIEVED BY February 10, 2012
Cost: $325
Make Check Payable To:
Loren Jackson
608 Patriot Way
Lakewood, NJ 08701