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Florida Half Century ASA, Inc.

Registration Form For 2017


Team Name:
Classification:
Team Contact Person:
Address:
City, State, Zip:
Phone: Cell:
Email:
Field Manager:
Address:
City, State, Zip:
Phone: Cell:
Email:
Registration Fee is $150.00 (US funds) made payable to:
Florida Half Century ASA, Inc.
MAIL COMPLETED FORM TO:
Bud Wortendyke
8140 52 Ln N
Pinellas Park, FL 33781