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Northeast Selects                
2007    REGISTRATION FORM

Name ____________________________________________________________________

Address ___________________________________________________________________

City _________________________ State________ Zip ________________

Birthday _____/_____/_____  Age _____

05—06 Team __________________________________

Parent’s Name ________________________________

Phone (H)_________________ (W) ________________

Email: _______________________________________

Age Brackets: (check one)

___  1999 & Younger     ___  1998    ___  1997  ___  1996  ___  1995                          

___  1994    ___  1993    ___  1989 thru 1992  ___  Girls 14U, 16U or 19U

 
$30 evaluation fee
$200 deposit
$125 balance due 4/18/07
 
Make Checks Payable to: Karin Judd

Mail Registration & Try-out Fee to:   

Northeast Selects
ATTN: Karin Judd
369 Sarhelm Rd.
Harrisburg, PA  17112
717-652-8584