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Coast to Coast Baseball

Non-Player Registration Form

FULL LEGAL NAME: ________________________________________________________

ADDRESS: _______________________________________________________________

CITY: _____________________________________________ STATE: _______

ZIP: _______________

PHONE: (______) _____________________

EMERGENCY PHONE: (______) ___________________

EMAIL ADDRESS: __________________________________________________

BIRTHDATE: __________________ SOCIAL SECURITY: _________________________
MM/DD/YY

PLAYER’S NAME WITH WHOM YOU’RE TRAVELING: ___________________________

I hereby apply for the Coast to Coast Amateur Athletics, Inc. tour to: (CHECK ONE)

Trip Dates Ages Choice
PUERTO RICO Feb. 5 - Feb. 11 16-18 ______
PUERTO RICO June 14 - June 20 11-12 ______
PUERTO RICO June 21 - June 27 13-15 ______
PUERTO RICO July 12 - July 18 16-18 ______
NETHERLANDS June 28 - July 11 16-18 ______
AUSTRALIA July 5 - July 18 16-18 ______

I have read and approved the itinerary, tour price, payment schedule, responsibility and cancellation clauses as they appear in the Coast to Coast Amateur Athletics, Inc. contract. I further agree to hold Coast to Coast Amateur Athletics, Inc. free from liability due to injury suffered during tour competition and will furnish documentation showing full insurance against injury (medical). Further, in the event Coast to Coast Amateur Athletics, Inc. is asked to participate in any of the following, I agree to participate in all television filming, newspaper interviews, movies, film commercials and questionnaires. I have no objection to being included in photographs, slides or movies taken during the tour which might be used for purposes of interpreting, marketing, promoting and publicizing Coast to Coast Amateur Athletics, Inc. or this particular tour.

CHECK ONE

______ REGISTRATION DEPOSIT ENCLOSED: $350.00 non-refundable registration fee (checks payable to Coast to Coast Amateur Athletics, Inc.)

______ REGISTRATION PAYMENT MADE ONLINE.
Online Confirmation Number: ___________________________________________

______ REGISTRATION FAX (Use Credit Card Authorization Form).


SIGNATURE: ____________________________________________

DATE: ___________________

 


Coast to Coast Amateur Athletics * P.O. Box 389 * Marietta, OH 45750
PHONE 928-854-9455 * FAX 928-854-6669

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