410 N. Arlington Heights Rd., Arlington Heights, IL 60004
847-577-3000 fax 847-506-2735
Print this form. Drop-off/mail your completed registration form with payment to Kevin Keister,
Arlington Heights Park District, 410 N. Arlington Heights Rd., Arlington Heights, IL 60004 or
FAX your registration form to 847-506-2735.
Check One: A-League _____ B-League _____
Team Name __________________________________________________________
Captain Name _______________________________________________________
Street _____________________________________________________________
City __________________________________________ Zip ___________________________
Phone (hm.) ______________________________ (wk.) ______________________________
Co-Captain Name _____________________________________________________
Street ______________________________________________________________
City __________________________________________ Zip ___________________________
Phone (hm.) _______________________________ (wk.) _____________________________
League Fee: $ 620.00
Payment: [ ] Cash [ ] Check [ ] Charge Card Info: ___ Visa ___ MasterCard ___ Discover
Cardholder No. _______________________ Expiration Date _____
Signature ______________________________________________
Include fees assuming you will make it into all leagues you are interested in. Make sure you have included all the information needed.
_____ Form filled out and enclosed.
_____ Roster filled out (names, addresses and phone numbers) and enclosed.
_____ Please check here if you would like to hold your spot with a credit card and make payment later.
Office Use Only: Code ________