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Name of Congregation*

Address of Congregation*

Street Address City State ZIP Code

Congregation Phone*

Congregation Email*

Total Number of Participants*

Number of Jr. Teams*

Number of Sr. Teams*

Total Teams

Do you have any special needs participants?

Do any of these participants require assistance? If so, please let us know.

Do you have any 5 year participants?

List Your 5 Year Participants

Do you have any 10 year participants?

List Your 10 Year Participants

Do you have any 15 year participants?

List Your 15 Year Participants

Scorekeeper Name*

Scorekeeper Email*

Primary Contact Name*

Primary Contact Email*

Enter Email Confirm Email

Primary Contact Phone*

Please check this box once you have watched our informational video.*

Yes, I have watched the video.

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Cardholder Name