2011-12 Winter League Registration Form
*Please note that ALL fields are required.

***WOMEN: Use www.WBGBL.com***

First Name:
Last Name:
Phone:

Address:
City:
State and Zip:
Email:

Date of Birth:
Height:

Preferred Division:
Have you played in the league before?
Were you referred by a current player? If so, who?:
How many games will you miss during the year?:
Self-evaluation / Level of play:





Position (check all that apply):




Shirt Size:





Jersey number preference (Choose 3):
Emergency Contact (Name & Phone):
Comments:
I have read and understand the conduct statement and have executed the waiver and release of liability.
(REQUIRED)
 
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