MODIFIED MADNESS 3 on 3" Tournament Registration Form

OCTOBER 5 th, 2013 Town Park, Milton, New York

(and/or Marlboro Intermediate School in the event of heavy registration or bad weather)

TEAM NAME CONTACT PERSON PHONE NUMBER EMAIL

TEAM ROSTER: NAME AGE

All teams eligible. Divisions and appropriate opponents to be determined based upon registration. Contact Dan Rusk at danrusk@rwhm.com with any questions. Complete and return form, together with registration fee (suggested donation no less than $50) by cash or check payable to Marlboro Central School District to : c/o Save Modified, 1390 Route 9W, P.O. Box 727, Marlboro, New York 12542 ALL PROCEEDS DONATED TO SAVE MODIFIED BASKETBALL. THANK YOU FOR YOUR SUPPORT!