Please provide the following contact information:

First Name
Middle Initial
Last Name
Home Phone
E-mail

Address

Street
City
State
Zip Code

Please identify and describe yourself:

Date of Birth
Playing Age (As of May 1st, 2010)
Sex	Male Female
School
Grade
Shirt Size:	YS YM YL AS AM AL AXL
Home Phone:
E-Mail Address:
Father’s Name:
Work/Cell #
Mother’s Name:
Work/Cell #
Primary Position:	First Base Second Base Shortstop Third Base Pitcher Catcher Outfield
Secondary Position:	First Base Second Base Shortstop Third Base Pitcher Catcher Outfield
Emergency Contact:
Relation:
Cell Phone #:
Home Phone #:
How did you hear about our camp?	TV Ad E-mail Website Word of mouth Baseball Clinic Mail Out Other
If Other, Please specify where
A note from a doctor stating that the player is physically able to participate in the tryout or a copy of a physical examination from this calendar year is required by the first day of the tryout to participate.  If a player has already attended a Big Leagues event this year where we required a doctor’s note, we have your form on file.
Payment by Credit Card:  Mastercard or Visa only! To pay via credit card, please fill out the section below.
Type of Credit Card	Mastercard Visa
Name as it appears on card:
Credit card number:
Expiration date:
Full Amount to be charged: