Registration - Dunedin Pirates Football

Pirates Player Registration

Date

Today's date

Player Information

Player Last Name

Player's last name

Player First Name

Player's first name

Player's Middle Initial

Player's middle initial

Player DOB

Player's DOB

Player Weight

Player's weight

Player Address

Street Address

City

Country

Player's address

Player Cell Phone

Player's cell phone number

Player Email

Player's email address

Emergency Contact Information

Emergency Contact Name

Emergency contact name

Emergency Contact Phone

Emergency contact's phone

Employer Information

Employer Name

Employer name (if unemployed, type N/A)

Job Title

Job title (if unemployed, type N/A)

Employer Address

Street Address

City

Country

Employer address (if unemployed, type N/A)

Manger Name

Manager's name (if unemployed, type N/A)

Manager Phone

Manager's phone number (if unemployed, type N/A)

Postion & Uniform Information

Positions (in order of preference)

Positions in order of preference.

Jersey Number Preferences (pick several numbers)

Jersey number preferences. Pick several numbers using NFL numbering for your primary position.

Comments

Payment

Discount

Subtotal

Tax

Total USD