Registration

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$700 per team. May 13th, 20th, 27th, June 3rd, 10, 17th, 24th ONLY TEAM CAPTAIN NEEDS TO REGISTER ***After registering, email gm@pinnacle-athletics to receive a roster/policy agreement form***

Event:

Start Date/Time:

End Date/Time:

Fee per Family:

Room:

* - denotes required fields

Information

	First Name:*	Last Name: *
	Home Phone:	Cell #: Work #:
	Email:	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *

Additional Information:

Other Questions/Comments:

Credit Card Verification:

Card Number: *

Name as it appears on card: *

Nickname:

Card Expiration Month: *

Exp Year: *

Address Line 1:

Address Line 2:

City:

State: Zip:*

eCheck/Bank Draft:

Bank Name:

Bank Routing Number:

(9-digit number)

Your Account Name:

(Your name on your bank statement)

Your Account Type:

Account Number: