LCWSA TEAM REGISTRATION INFORMATION

Team Name ________________________________________

Division Over 30 _____ Over 40 _____

Team Representatives:

Name ______________________________ Name _________________________________

Home Phone ________________________ Home Phone ____________________________

Cell Phone __________________________ Cell Phone ______________________________

Email ______________________________ Email ___________________________________

Team Colors -- Predominant _________________ Alternate _________________

Home Field Desired ______________________________________

THIS FORM MUST BE ACCOMPANIED BY TEAM FEES

CHECKS SHOULD BE MADE PAYABLE TO LCWSA