Basketball Registration Form

Name*

First NameLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

DOB* Date Of Birth Shirt Size *

E-mail*

Phone Number:*

Area CodePhone Number

Emergency Contact*

First NameLast Name

Relationship: *

Phone Number*

Area CodePhone Number

Registration

Individual Cost $125.00

Registration Fee for the February 17 basketball league at Rockville Sportsplex.60 Southlawn Court, Rockville MD - Start Time 12:30PM

Membership Dues$10.00

Annual Dues if you are not already an MCSSA member..

Total $0.00

The participant assumes all risks associated with participation in the above activities. MCSSA assumes no liabilty for injury or damages arising from participation in these activites. Due to the strenuous nature of some activities. MCSSA encourages each participant to consult his or her physician concerning fitness to participate in the program. The participant consents to emergency treatment.

Signature*

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By clicking the "Pay Now" button you are submiting your online registration for the 3on3 league and will be re-directed to Paypal to submit your payment. Once we recieve your payment, we will contact you by email about your registration.

Thank you!

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