Michigan Burn Tryout Registration Form

Michigan Burn Elite 64 ID Session Registration Form

Please complete all fields to register for the Elite 64 ID Sessions at 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 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 Elite 64 ID Session Registration Form