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Insurance Purchase Form
TEAM INFORMATION
*
Team Name:
*
Street Address - City/Town/ Zip Code:
*
Age Division:
10U/Rookie Division Birth Dates 9-1-2014 Thru 8/31/2018
12U Division Birth Dates 9/1/2012 Thru 8/31/2014
14U Division Birth Dates 9/1/2010 thru 8/31/2012
16U Division Birth Dates 9/1/2008 Thru 8/31/2010
Senior Division 18-23 Birth Year 2002 thru 2008
Comments:
COACH INFORMATION
*
Head Coach Name:
*
Head Coach Email:
*
Head Coach Phone Number:
PAYMENT INFORMATION
Insurance Fee is $185
Payment must be made before insurance can be purchased.
Payment options are Check or Venmo and can be collected at any Metro Meeting, mailed or sent at any time after this form is completed.
They should be labeled as follows:
Insurance Fee- Team Name- Age Division ($185)
sent to MGSL Ferris @Dennis-Ferris-3 (photo of Dennis with a fish)
Checks should be made out to MGSL and should be tagged the same as above:
You can mail checks to Dennis Ferris 137 Quail Hollow Lane East Amherst, NY 14051
*
Choose Payment Type:
Check
Venmo
Cash
* indicates required fields