ODYSSEY SPORTS

2004 Junior Olympic Registration form

Please complete all of the following

Name

Street Address

City, State, Zip

Social Security # ____________________________________________________________

Phone # ________________________ Email _________________________

Date of Birth

School District

T-shirt size __________ Sweatshirt size ___________ Shorts size ____________

Number choice (numbers 1-99 will be given on a first come – first serve basis!)

1^st ____________ 2^nd ____________ 3^rd ______________

Please enter the appropriate fees on the lines at the far right and then total at the bottom.

ODYSSEY SPORTS JUNIOR OLYMPIC FEE ($375.00) ___________________

PRESEASON WORKOUT FEE ($40.00) ___________________

EAST COAST CHAMPIONSHIPS FEE ($235.00) ___________________

TOTAL ___________________

I HAVE READ ALL OF ODYSSEY SPORTS’ POLICIES. PLEASE SIGN BELOW.

Please Send Check Payable To:

Frank Stackiewicz

887 Blue Ridge Road

Pittsburgh, Pa 15239

Parent/Guardian Signature Date Player Date