Michigan Burn Tryout Registration Form

Michigan Burn Player Registration Form

Please complete all fields to join the Michigan Burn. For more information contact Joe Gallagher at 586-876-0109 or joegall8@hotmail.com.
Parent or Guardian Name*

First NameLast Name
Player's Name*

First NameLast Name
Player's Age*
Player's Date of Birth*

MonthDayYear
Date
Player's Birth Year*
Player's Gender*
Current Club*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Email*
example@example.com
Comments
Should be Empty:

Michigan Burn Player Registration Form