Team Name: _____________________________

Captain Name: _________________

Email Address:__________________________ Phone: ______________

Address: ______________________ City: ________ State: ______ Zip: ________
 
Name of Player 2 : _________________

Email Address:__________________________ Phone: ______________

Address: ______________________ City: ________ State: ______ Zip: ________
 
Name of Player 3 : _________________

Email Address:__________________________ Phone: ______________

Address: ______________________ City: ________ State: ______ Zip: ________
 
Name of Player 4 : _________________

Email Address:__________________________ Phone: ______________

Address: ______________________ City: ________ State: ______ Zip: ________
 
Payment Options:
Mail this registration form along with your check or credit card information to the following address:
Checks should be in the amount of $100 and made payable to MECA, Inc.
MECA, Inc. 1611 Peach Street, Suite 135, Erie, PA 16501

Credit Card
Card Type: __ Visa __ Mastercard __ Amex __ Discover

Name of Card : _________________

Card Number:__________________________ Expiration Date: _____

CID: ____ (3 digit # on back of card, if Amex: 4 digits # on front of card)

Signature: _________________________________

For more information, call Laura at 454-9113 ext 226

Scorecard Pick Up: Get your cards at 815 State Street between 8AM to 10AM on event day!
Shotgun Start: 10AM (Must be 21 years of age or older to participate)