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FOB#                    *PIN#

_________________________________________________
*NAME

_____/_____
BIRTHDAY (MONTH and DAY)

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*ADDRESS

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*PHONE

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*CITY, STATE and ZIP CODE

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EMAIL ADDRESS

Do you live EAST or WEST of BENEVA and NORTH or SOUTH of FRUITVILLE? (Please Circle)

*Is this membership primarily for SELF, CHILD or TEAM? (Please Circle)

CHILDREN and BIRTHDAYS (First Name and Month and Day Only)

_________________________________________________           ____/____

_________________________________________________           ____/____

_________________________________________________           ____/____

_________________________________________________           ____/____

(OPTIONAL)

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IF THIS IS A TEAM MEMBERSHIP:

_________________________________________________________________.
*TEAM NAME

*ADULT or YOUTH

*SOFTBALL or BASEBALL

*TYPE OF TEAM __________________________ (AAU, TRAVELING, ALL-STARS, ECT.)

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*WHERE ARE YOUR HOME GAMES HELD?

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*REQUIRED FIELDS