EmailMe Form - 2014 HBCU Lacrosse All Star Showcase

REGISTRATION FORM

Registration for players wishing to participate in the youth tournament or the North-Vs-South game. (Managed by the staff at HBCU Lacrosse Consortium)

REGISTRATION DEADLINE - OCTOBER 19, 2014
Name *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone *
### - ### - ####
Email *
Education Status *
Middle School
High School
College
Alumni / Graduate
School Attending / Last School Attended if Graduate *
Grade Level / Graduation Year *
Primary Position *
Secondary Position *
Coach's Name *
First Last
Coach's Email *
Coach's Telephone # *
### - ### - ####
Top 4 Jersey Number Choices
Jersey Size (Adult Cut)
Video Clip Upload (30-60 Seconds Only):
Video Clip URL (YouTube, Facebook, Twitch, etc.):