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Payment Information:      (Your registration will not be complete until we receive your payment information)

^{Player Name:    Tryout:}   --Select Level-- Squirt Major Pee Wee Minor Pee Wee Major Bantam Minor Bantam Major Midget Minor Midget Major Girls U12 Girls U14 Girls U16 Girls U19

^{Email Address:}   

^{Payment Method:} Visa MasterCard Check Cash        ^{Amount Due:  $130.00  ($150 at the door)}

^{Card Number: Exp Date:} Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

^{Name on Credit Card:}

 
Signature:  ____________________________________________________

                        ^{(Note: a 3% Service Charge will be added for all Credit Card Transactions)}

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TRYOUT FEE: $130 (*Pre-Registrations)    $150 (at the door)
* Pre-Registration ends the at 2:00pm the last business day before the 1st try-out
NON-REFUNDABLE  (Jersey Included)

Make your check made payable to:
Chicago Mission

Complete and print this form and mail to:

Mission Fall Tryouts
Andrea Hahn
6690 S. Route 53 St.
Woodridge, IL  60517

or fax it to 630-521-1150

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