Keystone Blazers

Carroll Bros Shooters Camp Registration

Please use the form below to register and send payment per person to:

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

Current AAU members - $150.00

Non-AAU members      - $162.00

Registration Deadline - July 1, 2006

or pay securely on-line by clicking here  (Please add a $2 processing fee when paying with credit)

Name
Attended Before: Yes No
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
Click Arrow to Select Shirt Size
Sex Male Female
Height

 

Copyright 2006 [Keystone Blazers]. All rights reserved.
Revised: 06/13/06