Keystone Blazers

Tryout Registration

Please use the form below to register and send $20 payment

(+ $2.00 processing fee if paying by credit card) per person to:

Keystone Blazers Basketball Club - P.O. Box 698 - Oaks PA. 19456

or pay securely on-line by clicking here    (Please add $2.00 Processing Fee for Credit Card payment)

Please provide the following contact information per registrant:

Name
Street Address
Address (cont.)
City
State
Zip/Postal Code
Parent's Names
Emergency Contact Phone
Home Phone
FAX
E-mail

Please identify and describe yourself:

Date of Birth
Current Age
Current Grade
Ability Beginner Average Advanced AllStar
Sex Male Female
Height
Copyright 2006 [Keystone Blazers]. All rights reserved.
Revised: 02/09/06