Name                                                                 DOB

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Indicate fees attached:
Please check all that apply:

__ $100.00 League Fee

__ $20.00 Coaches Fee

__ $30.00 Team Insurance

__ $39.00 Field Maintenance

($13 x 3 lineups)

__ $360.00 Umpire Fees
($30 x 12 games)

Total Enclosed:
$ _________