Cost per team: $150.00
Official Referees
5th and 6th Grade Division/ 7th and 8th Grade Division
Registration Deadline: January 13, 2017
Contact Keith Hedges at the Warren YMCA for more information
Contact # (814) 726-0110 ext. 117 or [email protected]
_____________________________________________________
TEAM NAME: ______________________________________________
SCHOOL NAME:_____________________________________________
# OF PLAYERS: _____________ DIVISON: _______________________
COACH NAME: ______________________________________________
COACH PHONE NUMBER: ______________________________________
EMAIL:_____________________________________________________
ADDRESS:_________________City:_________State:____Zip:_________
____Cash
_____Check (checks payable to Warren YMCA)
____Credit/Debit Card:
Name on Card:_______________________________
Card #:_______________________________
Expiration Date:_____/_____ CVV Code:______
Card Type:____________
Signature:___________________________________
Return Registration form and payment to:
Warren YMCA
Attn: Keith H.
212 Lexington Avenue
Warren, PA 16365