ASA OF PA

Mother's Day White Rose NQ Application

May 12-13, 2012 - York, PA

ONLY ASA of PA Registered teams are eligible to participate.

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

Make your check payable to "ASA of PA" for $435 and mail to Tina Sanders, 266 S Christian St., Cleona, PA within 7 days of submitting entry.

12U, 14U MOTHER'S DAY ASA/USA QUALIFIER

TEAM NAME*

AGE GROUP *

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.