Mid-Atlantic Magic Girls Basketball

Where the region’s elite come to play…

2012 Registration

Name:_____________________________________________________________

Referred by:_________________________________________________________

Date of Birth:__________________________________ Current Age:___________

School: ________________________________________________ Grade:______

Address:___________________________________________________________

City: _______________________________   State:________   Zip: ____________

Home Phone: _______________________________________________________

Previous AAU experience: _____________________________________________

Positions played: ____________________________________________________

Uniform size (adult sizes only): _________________________________________

Health Insurance Provider:____________________________ #:_______________

Parent Information:

Parents’ names:_____________________________________________________

E-mail address: _____________________________________________________

2^nd E-mail address:__________________________________________________

Mother’s Work/ Cell phone:____________________________________________

Father’s Work/ Cell phone:____________________________________________

Please mail all registration deposit checks and registration forms to:

                        Mid-Atlantic Magic Girls Basketball

                        15057 Poquessing Creek Lane

                        Philadelphia, PA  19116

A registration fee of $450 is due prior to or at the first tryout; please make checks payable to Mid-Atlantic Magic Girls Basketball.  Families requiring a more flexible payment option should contact Fran Young at mamagic@comcast.net.  Players not selected will receive a full refund.