DEFENDER BASKETBALL

                                        Official Sign Up Form

PLEASE COMPLETE.  Mail check $175 in self addressed envelope to Fellowship for Athletes Inc. 155 North 18^thAve Hiawatha, IA, 52233 Make checks payable to FFAI .   

We would like all registrations in by Oct 9th, 2011. 

* Required fields
Name *
E-mail Address *
Address, City, State, ZIp *
Player Age *
Player Grade *
Player Weight *
Player Height *
School Attending for 2011 *	Public Private Homeschool Both
Church/Denomination *
Player Email Address *
Player Cell Phone
Player Uniform Number (Please indicate top 3 choices, numbers may not be available) *
Player Jersey Size (Adult Sizes) *	Small Medium Large X-Large XX-Large
Player Short Size (Adult Sizes) *	Small Medium Large X-Large XX-Large
Player Warm up Pants (Varsity Boys only)	Small Medium Large X-Large XX-Large
Player Warm up Top (Adult Sizes) *	Small Medium Large X-Large XX-Large
Player Practice Jersey *	Small Medium Large X-Large XX-Large
Father/Guardian Name *
Mother/Guardian Name *
Father's Work Phone *
Mother's Work Phone *
Father & Mother Cell Phone Numbers *
Defender Season Pass (good for all home games including home tournaments) *	Individual $25 Family $50 No Pass
Emergency Contact Information (Inlclude Doctor's name, cell, phone numbers and hospital preference) *
Health Information (Please list any health concerns)

I have read and agree to the Privacy Policy *

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© 2006 Fellowship For Athletes Inc.  All rights reserved