Player Last Name ________________________________
Player First Name ________________________________
Phone ____________________________________
Please staple $200 uniform deposit check post-dated to June 1, 2017
STAPLE CHECK HERE
# ______________(to be filled out by club)
Uniform Deposit 2017 season
Please fill out your name at the top of this form & staple $200 check
made payable to Chaminade Lacrosse Club in the corner. Mail form to:
Brian Sullivan Chaminade Lacrosse 2460 Clarjon, Manchester, MO
63021 This check will be shredded when your uniform is returned in
good condition.