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2019 Oakville Longhorns Registration

PLAYER INFORMATION

* First Name:

* Last Name:

* Address:

Apartment / Suite::

* City:

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* Country:

* Postal Code/Zip Code:

* Phone Number:

* Birthdate:

* Email Address:

* Jersey Number:

* Alternate jersey number:

* Jersey Size:

* Position:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

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