ASA OF PA

14U B State Champ Entry

July 6, 7, 8, 2012

Complete all information and click on "Submit". Your information will be emailed to Suzanne Robison - Tournament Director.

Make check payable to "ASA of PA" for $450 and mail to Suzanne Robison, 1081 Pebble Court, Mechanicsburg, PA 17050 within 7 days of submitting entry.

14U CLASS B STATE CHAMPIONSHIP

TEAM NAME*

MANAGER'S NAME *

First Name

Middle

Last Name

MANAGER'S ADDRESS *

Address Line 1

Address Line 2

City

State

Postal Code

HOME PHONE*

CELL PHONE*

EMAIL ADDRESS*

TEAM'S HOME DISTRICT OR COUNTY*

NOTE: 2012 ASA Background Checks required for all adult members of team. At least 1 coach must have 2012 ACE Certification. Proof of clearance and/or completion must be presented at check-in.