|
|
||
|
389 Bryan Pt. Drive, Chula Vista CA 91914 Web Site: www.usabf.com Email: USABF Phone: (619) 934-2551 Fax: (619) 271-6659 |
||
 |
||
|
(1) Complete form, (2) sign, (3) print and (4) fax or mail to USABF Fax Number and Address are Listed Above |
||
| Event Name | ||
| Team Name: | ||
| Manager's Name: | ||
| Mailing Address: | ||
| City: St: Zip | ||
| Home Phone Fax: | ||
| Cell Phone Email: | ||
|
Entry Fee |
||
|
Payment in Full: $ |
||
|
Or Deposit: $ Non-Refundable |
||
| Payment Method: Check# | ||
| Credit Card: Visa MasterCard American Express | ||
| Expiration Date: **Security Code | ||
| **Your card security code for your MasterCard or Visa card is a three-digit number on the back of your credit card, immediately following your main card number. The card security code for your American Express card is a four-digit number located on the front of your credit card, to the right or left above your main credit card number. | ||
| Name on Credit Card: | ||
| Billing Address: | ||
|
||
| Phone: |
