TEAM ROSTER FORM

(please print clearly)

PRINT AND FILL OUT THIS REGISTRATION FORM, and send it in with individual registration forms,
waivers and payment(s).

REGISTRATION IS OPEN TO A LIMITED NUMBER OF TEAMS. ONCE WE HAVE REACHED THAT LIMIT WE WILL NO LONGER
ACCEPT REGISTRATIONS. WE WILL ONLY CONFIRM YOUR PARTICIPATION ONCE PAYMENT HAS BEEN MADE IN FULL AND
ALL FORMS SUBMITTED.

Team Name: ____________________________________________________________________________

Fee: $300.00
ALL FEES PAID FOR XTREMBOL ARE NON-REFUNDABLE. PAYMENT MUST BE MADE IN FULL UPON REGISTRATION.

Coach/Team Representative Information:

Person’s Name: ______________________________________________E-Mail:_____________________________________________
*We can notify you and all others on your roster of schedule changes if we have an e-mail address*

Daytime Phone:(_____) _________________ Evening Phone:(_____) ________________ Fax:(_____) __________________

Home Address:______________________________________________City:__________________ State: _____ Zip:___________

Note: Limit Eight (8) players per team.

Team Roster/Waiver Sheet: (please print clearly)

Names, Address, Phone Numbers, E-Mail Address,
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Mail the completed Team Roster Form, the Registration/Waiver and Release Forms and Payment to:

XTremBol Productions, LLC

Attn: Andres F. Torres
8 Slope Drive
Dover, NJ 07801