Walton Lacrosse Booster Club
2009-2010 Registration
Team: Boys Girls (please circle)
PLAYER:
Last Name: First Name: Nickname:
Address:
City:
Zip code:
Date of Birth:
Grade:
Homeroom Teacher:
Other Walton Sports You Play:
Home Phone: Cell:
E-mail Address:
MOTHER:
Last Name: First Name:
Home Phone: Cell:
E-mail: Work:
FATHER:
Last Name: First Name:
Home Phone: Cell:
E-mail: Work:
Volunteer Interests (Committees):
If mailing form and payment, please make check payable to: Walton Lacrosse Booster Club; mail to Al Daniel, 699 N. River Forest Ct. Marietta, GA 30068
Booster Club Use Only
Booster Club Dues: $450 Check #: Date paid:
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