Phoenix Scorpions Field Hockey Club

TEAM NAME:

DIVISION: Men Women Mixed Under-19 (Boys) Under-14 (Mixed) Under-11 (Mixed)

TEAM CONTACT:		PHONE:
ADDRESS:		CITY:
STATE, ZIP:
E-MAIL:
TEAM UMPIRE:		(mandatory)
E-MAIL:		(mandatory)

           First Name, Last Name                                                                     DOB (only required for U-18, U-13)

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Make payment out to Phoenix Scorpions and mail to:
           Phoenix Scorpions
           1532 N. Robin Lane
           Mesa, AZ 85213

Your registration can not be completed until the payment is received.

           E-MAIL:    PhoenixScorpions@hotmail.com

Property of the Phoenix Scorpions Hockey Club