ASA OF PA

16U A State Champ Entry App

June 22 - 24, 2012 - Drifton, PA

Complete all information an click on "submit". Your information will be emailed to Tina Sanders -Tournament Director.

Make check payable to "ASA of PA" for $450 an mail to: Tina Sanders, 266 S Christian St., Cleona, PA 17042 within 7 days of submitting entry.

16U Class A 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.