First Name: Last Name:

Address: City: State: Zip Code:

E-Mail Address: **** Critical if you want to be notified of start times and get a confirmation.

Daytime phone No. Evening or Cell phone No.: **** Please make sure to give us at least one good number in case there are questions or changes.

Junior Information: ................Choose One: NONE Boy Girl .....................Age: NONE 6 7 8 9 10 11 12 13 14 15 16 17 18

Club Affiliation :

Special Tee Shirt: Each Player in the event will be provided court time, racquetballs, and hospitality as well as a special limited tee shirt.

Please select your Tee Shirt Size:(ADULT) NONE Small Medium Large Extra Large XX Large

ENTRY FEES:

$35.00 for the first event, $15 for the second event. Juniors are a $25.00 flat fee, up to 2 events. Payment can be made at the day of the tournament by cash or check made out to Breast Cancer Survival Center who is acting as the fiduciary for this event.

DONATIONS:

Your tax deductable donation below can be added to your entry fee by selecting the item below or simply making a donation. If you wish to make a donation by entering it by CCard using paypal you can click on the link provided.

I would like to add an extra Tshirt to my entry for an added $15.00 donation. Specify Size: NONE Small Medium Large Extra Large XX Large **** If you require more than one extra please email rbye@clconstruction.com

I would like to add the special music CD to my entry for an added $20.00 donation. The music CD is music all written and played by young adult cancer survivors.

I would like to add a LiveSTRONG wristband to my entry for a donation. (specify amount, Minimum $1) $

I would like to add a donation to my entry in the amount of (specify amount) $

If you would like to make a donation by Credit Card directly to Cancer Advocates Coalition, simply Click Here.....

ENTER YOUR EVENTS:

There is a 2-event limit in this tournament. Please select your events below, if you are only playing one event please select No Second Event from the list of events.

Please pick one event from the event selection below.

First Event Doubles Partner

Please pick one event from the event selection below.

Second Event Doubles Partner

Enter any Comments here....