FALL 2019 PAL/Miracle League Registration

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* 1. Player Information

Name *

Address *

Address 2

City/Town *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 2. Player Age

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* 3. Player Shirt Size

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* 4. Parent/Guardian Information

Name

Email Address

Phone Number

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* 5. Last Year's Team

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* 6. Emergency Contact Information

Name

Phone Number

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* 7. Comments/Requests