INTENT TO PARTICIPATE/ENTRY FORM
SUPER REGIONAL
(Phila. PA)

Please check age group:

11_____   12_____   13_____   14_____   15_____   16_____

PLEASE PRINT VERY CLEARLY THE FOLLOWING:

TEAM NAME: _____________________________________________________________
COACH'S NAME: _____________________________________________________________
E-MAIL ADDRESS: _____________________________________________________________
BUSINESS PHONE: _____________________________________________________________
HOME PHONE: _____________________________________________________________
CELL PHONE: _____________________________________________________________
ADDRESS: _____________________________________________________________
FAX NUMBER: _____________________________________________________________
ASST. COACH NAME: _____________________________________________________________
E-MAIL ADDRESS: _____________________________________________________________
ASST. COACH PHONE: _____________________________________________________________
CELL PHONE: _____________________________________________________________
TEAM PARENT NAME: _____________________________________________________________
E-MAIL ADDRESS: _____________________________________________________________
TEAM PARENT PHONE: _____________________________________________________________
CELL PHONE: _____________________________________________________________

Please fax this form to (215)491-6988
To complete registration Please mail payment of $465.00 to:
  FENCOR
PO Box 490
Warrington, PA 18976
*Payment must be received no later thaen 14 days prior to tournament date.