REGISTRATION FORM
2nd ANNUAL SAN DIEGO EAST COUNTY CHAMBER OF COMMERCE
CO-ED KICKBALL TOURNEY - BUSINESS AFTER HOURS MIXER
TUESDAY, APRIL 21, 2015
ALL PARTICIPANTS MUST BE 21 OR OLDER
Team Name
Phone # (s)
Address
City
Team Contact Person
E-mail address:
Zip
TEAM ROSTER (10-players)
Name
Player 1:
Player 2:
Player 3:
Player 4:
Player 5:
Player 6:
Player 7:
Player 8:
Player 9:
Player 10:
Email Address
Waver
Each player must sign an release form.
1ST ANNUAL KICK BALL TOURNAMENT & BUSINESS AFTER HOURS MIXER
Company: ______________________________________ Total Payment $ ________________________
Name On Credit Card : ____________________________________________________________________
___ Visa
___ Master Card
___ Am Ex
CCV Code: __________
Exp. Date: ________
Card Number: ___________________________________________________________________________
Billing Address including Zip ______________________________________________ ZIP ______________
Signature: ____________________________________
Mail to: SD East County Chamber 201 A. Magnolia Ave El Cajon, CA 92020