D-League Registration

Participants Full Name*

Date of Birth*

Gender*

First Time or Returning?*

Last Team Name*

Registration*

Please select one

Total

$0.00

Home Phone

Cell Phone

Email*

If member of Ararat, what section?

I'd like to volunteer as a

Name*

1st Preferred Practice Days*

(*practice day option is a preference only and can not be guaranteed)

Please accept*

($35 Processing fee will be deducted for all refunds or credits toward future seasons)

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address*

Street Address City State ZIP Code

Fall 2017 Season