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.