Putnam Athletic League

TINY-MITE CLINIC - $15
REGISTRATION FORM

By completing this form you are automatically registered for the Tiny-Mite Clinic.

This clinic certification expires after the 2012 season.

Clinic at Bradford High School at 519 North Orange Street Starke, FL
This clinic certification expires after the 2012 season.

A $10 late fee will be assessed for anyone who is not pre-registered,
pre-registration closes on July 14, 2010 then fee goes to $25.

Attendant's Name (first & last):
Phone with Area Code:
Email:
Address:
	City: , FL zip:

Title:
Putnam Association:

If you are not in the Putnam Athletic League, please complete this section.
League Name:
Association Name:
Do you need a hotel:	Yes No

Comments:

Method of Payment:

All fees are due prior to registration. A $10 late fee will be assessed for anyone who is not pre-registered. Any checks that are returned for insufficent funds will be subject to a $35 service charge.

By submitting this form you hereby agree to the terms of this agreement. You also take responsibility for payment of all fees. Fees are non-refundable, and by submitting this form you take full responsibility for payment.

I agree to the terms listed above.

Putnam Athletic League | www.putnamathleticleague.com | 15406 NW 202nd Street, Alachua, FL 32615