Activity Registration Form

XYZ League
123 Main Street
Anytown, CA, 00000
http://www.yourorganization.com

Participant Information

First Name

Last Name

Sex

Birth Date

Grade

Activity #

Fee ($)

First Name

Last Name

Sex

Birth Date

Grade

Activity #

Fee ($)

First Name

Last Name

Sex

Birth Date

Grade

Activity #

Fee ($)

* City Resident? (non-city residents add $5.00 for each participant)

Yes - I am a city resident

No - I am not a city resident

* Total Fees for all Participants:

Household / Adult Primary Contact

* First Name

* Last Name

* Address 1

Address 2

* City

* State

* Zip

Phone

Alternate Phone

* Email Address

* Indicates Response Required