2017 USSSA Baseball
State Tournament Entry Form
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Team Name
USSSA Sanction # (Starts with 814 or 914)*
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Manager Name
Email
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Cell Phone
Alternate Phone
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Address
City
State
Zip
2017 State Tournament Attending (must check one)
June 23-25th
o 8 & Under Kid Pitch – Lincoln Park Columbus ($350)
o 9 & Under AA – Lincoln Park Columbus ($400)
o 9 & Under AAA – Lincoln Park Columbus ($400)
o 9 & Under Major – Lincoln Park Columbus ($400)
o 10 & Under AA – Indy Sports Park ($400)
o 10 & Under AAA – Indy Sports Park ($400)
o 10 & Under Major – Indy Sports Park ($400)
o 11 & Under AA – Lincoln Park Columbus ($400)
o 11 & Under AAA – Lincoln Park Columbus ($400)
o 11 & Under Major – Lincoln Park Columbus ($400)
o 12 & Under AA – Indy Sports Park ($400)
o 12 & Under AAA - Indy Sports Park ($400)
o 12 & Under Major - Indy Sports Park ($400)
o 13 & Under AA - Indy Sports Park ($400))
o 13 & Under AAA - Indy Sports Park ($400)
o 13 & Under Major - Indy Sports Park ($400)
o 14 & Under AA – Indy Sports Park ($425)
o 14 & Under AAA – Indy Sports Park ($425)
o 14 & Under Major – Indy Sports Park ($425)
o 15 & Under OPEN – Columbus ($425)
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Credit Cards Accepted (Circle One)
All payments and entries must be received by 5pm no less than 1 week prior to the event.
MasterCard / Visa / Discover
*Deadline
to register: June 13th
Name on Card
Payment Information:
Tournament Fee
$________
Total Amount Enclosed
$________
(Make checks payable to Indiana USSSA for credit card info, see right)
Mail Form to:
Indiana USSSA Baseball
Attn. Kory Scaringe
1350-C W. Southport Rd
Indianapolis, IN 46217
317.919-6940
[email protected]
House Number & Zip Code – Linked to CC
Phone Number of CC Holder
Credit Card #
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Exp. Date
__________
Security Code
Signature of Authorized User