Registration Form - Dubset Summer Lacrosse Club Application 2017 - www.dubsetlacrosse.com

Mark Armogida 914-907-9925 / Howie Rubenstein 914-659-3199

Name: __________________________________

Address: _________________________________________________________________

________________________________________________________________________

Date of Birth: ____________________

Position: _______________

Home Phone: ___________________________

Player’s Cell #: __________________________

Parent Email: ____________________________

School: _________________________________________

Parent Signature: _____________________________________________

US Lacrosse Membership #:___________________________________

(Players must be a US Lacrosse member…you can sign up at www.uslacrosse.org, cost is $25)

Shirt Size (Please Circle): ..........S..........M..........L..........XL

Shorts Size (Please Circle): ..........S..........M..........L..........XL

Please mail application and $400 deposit ASAP to hold your roster spot.

Please make checks payable to “Tiger Sports."

Send to:

Mark Armogida
9 Quincy Lane
White Plains, NY 10605