Employee Name Who takes registration form: ____________________________Date:_____________Time:________________
Flagstaff Athletic Club Team Sports Sign-up: Teams must sign-up as a whole and pay at time of registration. NO EXCEPTIONS
Team Roster: Check one of the below sports & circle division
Indoor Volleyball – Min 6
[
Coed “A”
|
Coed “B”
Sand Volleyball
]
[
Indoor Soccer – Min 7/ Max 10
Coed 4’s “A”
|
Coed 4’s “B”
|
Coed (2’s)
|
Women’s (2’s)
| Men’s (2’s)
Special Event Team Sport:_____________________________________
Team Captain: ________________________phone #_______________________________E-mail____________________________________
Team Name: _________________________________________________________________________________________________________
Name
Member
Non-member
PLEASE PRINT CLEARLY
 if member
and Print Club #
 if non- member
and print Date of Birth
1
#
DOB:_____/_____/_____
2
#
DOB:_____/_____/_____
3
#
DOB:_____/_____/_____
4
#
DOB:_____/_____/_____
5
#
DOB:_____/_____/_____
6
#
DOB:_____/_____/_____
7
#
DOB:_____/_____/_____
8
#
DOB:_____/_____/_____
9
#
DOB:_____/_____/_____
10
#
DOB:_____/_____/_____
Phone #
Payment:
Signature
Cash, Check, or CTA
**Credit Card on back**
for CTA
]
Print credit card information below
Name On Card:
Credit Card Number:
Exp:
/
/
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
/
/
/
/
/
-
-
-
/
CVV2:
Signature