Registration - Belleville Minor Softball

Player Name *

First

Last

Date of Birth *

Gender *

Interested in the following positions:

Number of Years Played *

Parent / Guardian Name *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

If interested in assisting, please check:

Additional Comments

Pricing *

Price: $150.00

Payment *

This page is insecure. Credit Card field should be used for testing purposes only.

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