15^TH ANNUAL HESS FIELD

FIRECRACKER INVITATIONAL

REGISTRATION FORM

ASA SANCTIONED

JULY 1^st, 2^nd and 3^rd, 2011

Reminder: Depending on the number of teams, playing time could start as early as 12:00 p.m. on Friday

PLEASE INSERT CHECK PAYBLE TO S.C.A.S.A. AND THE COMPLETED FORM BELOW BY THE DEADLINE DATE OF JUNE 24^th, 2011 AND MAIL TO:

Jann Duck

147 Middle Street

Centre Hall, PA 16828

Phone (814)364-1053

Email: psujrduck@verizon.net

or

Visit our website at www.asaofpadist8.org for more information on directions and lodging

Division* (please X): 18 & U_____ 16 & U_____

* If you are bringing more than one team, please fill out separate registration forms for each team.

Feel free to duplicate this form and distribute.

Team Name: _________________________________________________

Manager’s Name: _________________________________________________

Address: _________________________________________________

City, State, Zip: _________________________________________________

Phone Number: Home___________________Cell____________________

Email Address: __________________________________________________