Adult Volleyball Registration Form

*** Full Payment Is Due With Registration ***
Fill-out form, Print, and Sign
Drop-off or mail your completed registration form with payment
to Kevin Keister, Arlington Heights Park District
410 N. Arlington Heights Road
Arlington Heights, IL 60004 or
FAX your registration form to 847-506-2735.

Team Name
Captain's Name Co.Capt.'s Name
Street Street
City   Zip City   Zip
Phone (hm) Phone (hm)
(wk) (wk)
(fax) (fax)
E-mail E-mail
       
1st League:   Fee:
 
2nd League (this is not a second choice):   Fee:
 
       
$10.00 off each league for two or more Discount
(The captain must remain the same for each league)
Please put the names of each league up at the top
and which league it is for.		 Total Due

Payment:
Cash (must bring in-person)
Check
Charge

 
    1) Visa     MasterCard     Discover
    2) Cardholder Number - - -
    3) Exp. Date /
    4) Signature ___________________________________________ (print and sign)