EmailMe Form - Organization Information for Courtesy Facility Use

OFFICE USE ONLY

Date Received

Contract Mailed

PLEASE COMPLETE THE FOLLOWING

Name of Organization *

Sport *

Organization Official's Mailing Address *

Organization Official's Phone Number *

Organization's Address *

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

Please list each division and number of teams/players that participated in the 2012 season. *

Name of Organization Official *

Organization Official's Mailing Address *

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

Organization Official's Home Phone *

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Organization Official's Work Phone *

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Organization Official's Cell Phone *

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Organization Official's Email Address *

FAX Number if Available *

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Please list facilities below you are requesting for the 2013 season. Include a start date and an estimated end date.

This request will be reviewed by DPR and a contract will be mailed for the Organization's official's signature before practice schedules and game schedules will be accepted by DPR. Travel baseball teams should list field dimensions, days and times that they would prefer and DPR will give consideration to this request when assigning a location. *

Please list any additional Organizational Officers or alternate contacts, with a daytime and evening phone number for each. *