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SKU: EAGR

East Grassroots Registration Payment

$295.00

Player First Name *

Player Last Name *

Player Gender *

Player Grade *

Player School *

Player Medical *

Player T-Shirt Size *

Contact Emergency Cell *

Contact Email Address *

How Did You Hear About Us *

Other (please list)

Order / Registration Note(s)

Electronic Signature - By Checking This Box, I agree to the following *

Product total

Options total

Grand total