Player’s Name____________________________________________________________
Street Address____________________________________________________________
City______________________________State___________Zip____________________
Home Phone #: _____________________ Alternate Phone #: ____________________
E-Mail Address: __________________________________________________________
Birth Date: ________________________ Year of Graduation: ___________________
Scheduled Dates and Times:
Individual instructional sessions will be a minimum of one hour. Note:
Boy’s ages 7-11 will be a maximum of one hour in length. Member
fees can be found on the first page of the PGBA packet or www.petersburgsports.com.
Check #: _____________________ Amount _____________________ Date________
*Cash and Checks are acceptable forms of payment
