MSA -  MONTGOMERY SPORTS ASSOCIATION

REGISTRATION/
PAYMENT FORM BY MAIL

Sign up for:

Location

Fee each

Total:

Name:

Address:

City:

State/Prov:

Country:

Zip/Post. code:

Phone:

E-mail:

The credit information should not be sent via email. Please call us with the credit card information, or print form and mail it via US Postal service. Thanks

Method of Payment

Credit Card #:

Exp. date:

Name of The Card Holder

Parental Consent/Registration
My child is covered by medical insurance and any special medical conditions will be stated. The Organizers and their representatives are not responsible for any injury or damage that may occur.  I authorize session staff to act on my behalf in emergency.   I have read  MSA Policy and I agree to MSA - No refunds policy which states that only an MSA credit will be issued for future MSA activities .

Parent Signature

Please print this form and mail it with your payment to: