FULL NAME:

NICK NAME:

TEAMMATE(S):

TEAM NAME:

GAME: Circle the series you wish to participate in:           1-ON-1                 2-ON-2                 3-ON-3

FEE PAID: (Money order or cashier’s check made out to 1-2-3Play!)

                                                Age 13 – 17                         18 - 39                   40+                        

                1-ON-1                 $49                                         $99                         $99                        

                2-ON-2                 $39                                         $59                         $59                        

                3-ON-3                 $29                                         $39                         $39                        

DATE OF BIRTH:                                                                SEX (please circle): M   F               SHIRT SIZE:

MAILING ADDRESS:

CITY:                                                                                      STATE:                                  ZIP CODE:

PHONE #:                                                                            E-MAIL ADDRESS:

PLAYER/PARENTS SIGNATURE: _____________________________         DATE: ____________

SCHOOL CURRENTLY ATTENDING:                                                                                                            GRADE:

Contact Information: Phone: (773) 969-2083; e-mail: eric@1-2-3play.com;

Mailing address: 123…Play! PO Box 248, Oak Park, IL 60303

 

*Sponsor reserves the right to deny participation to any individual and cancel tournament for lack of sufficient participation with all fees refunded via mail.