EmailMe Form - WMBA Tournament Application 2013

Team Name

City Representing

Division *

Rookie (June 7,8,9) - $400.00

Mosquito (July 12,13,14) - $400.00

Name of Primary Contact *

Contact Information *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Primary Phone Number *

### - ### - ####

Secondary Phone Number

### - ### - ####

Email *

Confirm Email

Name of Field Coach / Manager *

Directions for Submitting Payment by Cheque:

You will receive a confirmation email after submitting the form. Please print a copy of the confirmation email received and include it with your cheque for $400.00 to be mailed to:

WMBA c/o Rodney Naylor P.O. Box 20132, Woodstock, Ontario, N4S 8X8

Entry is on a first come / first serve basis and WMBA will only hold spots for teams that have submitted payment