**IMPORTANT**
Your registration will not be complete until we receive your payment information!

Payment Information:  

^{Player Name:       Birth Year 2004 2003 2002 2001 2000 1999 1998 Midget Minor U16 Midget Major U18 Girls U12 Girls U14 Girls U16 Girls U19}

^{Contact Phone#:     Email Address:}   

^{Payment Method: Visa MasterCard Check Cash        Amount Paid:}    (see below)

Credit Card Information: Card Number: Exp Date: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2012 2013 2014 2015 2016 2017 2018 2019    3 Digit Code: Name on Credit Card:                       Address:             City, State, Zip:     Signature:  ______________________________________________________                                        (Note: a 4% Service Charge will be added for all Credit Card Transactions)

YOU MUST PRINT THIS FORM! PAYMENT AMOUNT (all payments are non-refundable) Spring Boys 04 - 98    $75  tryout fee. ($50 for  2011-12 returning Mission players) NO TRYOUT FOR 04's, 03's & 99's    $595  for practice/Clinics (if selected) ($550 for returning  2011-12 Mission players) Spring Girls U12 - U19    $425  for practice/Clinics ($395 for 2011-12 returning Mission players) Spring Midget Prep Camp    $595 ($550 for returning  2011-12 Mission players)    ($350.00 non refundable deposit fee is required with Application) NON-REFUNDABLE  (Jersey Included) Make your check made payable to: Chicago Mission Complete and print this form and mail to: Chicago Mission Registration 6690 S. Route 53 Woodridge, IL  60517 or fax it to 630-521-1150

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