Team Name: ________________________________________________________ Division: ________________ Managers Name: ____________________________________________________ Home Phone: ____________________ Cell Phone: ______________________ Email Address: ______________________________________________________ Home Address: ______________________________________________________ Town: _________________________ State: _________ Zip Code: __________

Fill out Registration Form and send with Insurance To: MUCKDOG BASEBALL CLUB 2000 SYCAMORE LANE MAYSLANDING NJ 08330 A $200.00 Non Refundable Deposit Is Required ASAP To Secure A Spot. The Remaining Balance Is Due by MARCH 15TH.

Managers Signature: _______________________________ Date: __________