South Bay Sports and Special Events - Sporting League and Social in South Bay California

2009 SIGN UP FORM : LITTLE KICKERS & UPPER 90

(*) Required

CAMPER INFORMATION
Camper Name:*
Gender:*
Age:*
Date of Birth:*
T-Shirt Size:*
Medical Information:
Comments:

PARENT INFORMATION
Parent Name:*
Parent Email:*
Parent Phone (Day):*
Parent Phone (Evening):*
Parent Phone (Emergency):*

BILLING INFORMATION
First Name:*
Last Name:*
Address:*
City:*
State:*
Zip Code:*
Phone Number:*

PAYMENT INFORMATION
CAMP DATE(S) : Please select the Session(s) you want to purchase.
Camp Date(s):*	Session 1 - June 22-26, 2009 (Cost: $175) Session 2 - July 13-17, 2009 (Cost: $175) Session 3 - August 3-7, 2009 (Cost: $175)
CREDIT CARD : There will be a $10.00 processing fee for credit cards.
Type of Credit Card:
Full Name:
Credit Card Number:
Pin Number: (On the backside of Card)
Expiration Date:

BANK CHECK : If you are sending a check please select the box below.
	I will be sending a check to:
	South Bay Sports, LLC Po Box 755 Hermosa Beach, CA 90254

South Bay Sports, LLC completely respects our member's privacy and therefore is committed to keeping your information secure and confidential.
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