2012 REGISTRATION FORM
Lets Play Ball and Have Some Fun
PLEASE PRINT CLEARLY:
Last
Name: ____________________________
First Name: _______________________
Street
Address: ______________________________________________________________
City
or Town: ____________________________
Zip Code: ___________
Home
Phone: _____________________________
Uniform shirt size: ________
Email
address: __________________________________________________________
Would you like to receive
league communications at this email address in 2012? YES
NO (Circle One)
Date of Birth: _____________________ Age on
1. Have you participated in the UCSSL
previously? YES NO (Circle One)
2. If you
answered YES above, what team(s) did you play on?
(50s)
________________________________ (60s) _________________________________
3. Are you currently assigned to a
team(s)?
(50s) ________________________________ (60s) _________________________________
** NOTE: all NEW players must submit a photocopy of both
sides of their drivers license **
Cost for membership
in the UCSSL
.
$70.00
Total cost to play in
both the 50s and 60s
.
$125.00
All players: Please read the following, and sign where indicated.
The
STATEMENT
OF DISCHARGE OF LIABILITY
I sign this form as my Voluntary Act and by this act I
agree to exclude the Union County Senior Softball League and all of its
officers and League officials from any claims, suits or other actions arising
from, caused by, or which are the alleged result of any Act or omission by the
League.
I agree to participate in League play in the Union
County Senior Softball League at my own risk and any injuries which I may incur will be
paid for through my own personal medical plan or from my own personal funds.
This statement remains in effect as long as I
participate in the
I hereby certify that the above information
is correct, and I realize that I am liable to be banned from UCSSL for life if
the information is found to be false.
LEGAL SIGNATURE: ____________________________________ DATE:__________________
Return
completed form, with payment (and copies of license if you are new to the league),
to team manager, or mail to: UCSSL
938