Backcourt Hoops & NEPA Flames Online Registration Form:

[Note: After submitting form, you will be taken to a screen from which you can pay online via safe, secure PayPal with your credit card or online check. You will also be given information on how to pay by check instead.]

Tournament Name:          

Tournament Fee:           $ 

Team Name:                    

Team Street Address:    

City:                                   

US State:                               Zip:    

Boys or Girls Team     :    

Age   Group                 :       Level (A,B orC  :    

Coach's Name:                 

Coach's Email:                  (required)

Coach's Telephone:          (required) with area code

Coach's Cell  Phone:        (required) with area code

 

Comments/ Special Requests: we will attempt to honor your requests

     

       Player's Name                              Date of Birth             Number

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Additional players can be added via email