Team Classification				Team Division
Tier I AAA	Tier II - AA	Tier II - A		Squirt	Pee Wee	Bantam	Midget

^{Team Name:            
Head Coach:         
Team Contact:      
E-Mail Address:} 

^{Contact Phone#'s    (Check Preferred Phone Number) 
             Home:    Cell:
             Work:     Fax:}     

Comments:

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^{Payment Method:} Visa MasterCard Check Cash         ^{Amount Due:}  $900.00

^{Card Number: Exp Date:} Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2006 2007 2008 2009 2010 2011 2012

^{Name on Credit Card:}

 
Signature:  ____________________________________________________

                        ^{(Note: a 4% Service Charge will be added for all Credit Card Transactions)}

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Make your check made payable to:   Advanced Tournaments

Complete and print this form and mail to:

US National Championships
Kevin Mann
6690 S. Route 53 St.
Woodridge, IL  60517

or fax it to 630-521-1150

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