Alumni Game Participant Registration

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2013 Alumni Basketball Game Registration Form General Information (Please print clearly) Name: Address: City/State/Zip: Telephone:

Email: Birth date: T-Shirt Size: Year Graduated: Emergency Information Notify/Relationship: Address: City/State/Zip: Telephone: Information to share in program : Work Cell: S - M - L XL <Circle One> Cell: Gender:
M/F

This information can include but not limited to: where you attended college, where are you now? Family info, professional info, your favorite memory of participating in your sport during school.

Additional Information :
1. Contact Erin Lashinsky @ erin.lashinsky@homeinstead.com or 814-327-4744 for questions or further information. 2. Sign attached waiver and return completed registration and 20.00 fee payable to TMSDEF 3. Mail completed registration form and payment to : Tussey Mountain School District Attn: Emily Mervin 199 Front Street Saxton, PA 16678

Please get your registration in ASAP or before November 15, 2013. Watch your email for updated information. Practice date will be determined at a later time and will be emailed to participants.

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