Team Name :
Team Captain :
Regionals(s) Site(s) Played -List
Team Captain Address :
Address Line 2 :
City or Town :
State/Province :
Country :
Zip / Postal Code :
Phone :
Fax :
Email :

Credit Card Number  (Visa, MasterCard, Discover)
Expiration Date (Month/Year)
Registration Fee  (Will vary based on finish at Regionals) Call 847-239-6744 to verify amount
Address  (If different from above)
Cardholder Signature

Please CHECK ONE of the following divisions:

MALE DIVISIONS
8 VS. 8 CONTACT		Gold - Very Competitive
		Silver - Competitive
		Bronze - Play for Fun
7 VS. 7 NO CONTACT		Gold - Very Competitive
		Silver - Competitive
		Bronze - Play for Fun
4 VS. 4 NO CONTACT		Gold - Very Competitive
		Silver - Competitive
		Bronze - Play for Fun
		Over 35

YOUTH DIVISIONS
4 VS. 4 NO CONTACT		Ages 8 - 12
		Ages 12 - 16
8 VS. 8 CONTACT		Ages 12 - 16

FEMALE DIVISIONS
4 VS. 4 NO CONTACT
7 VS. 7 NO CONTACT

PLAYER # 1 - TEAM CAPTAIN
Name :		Jersey # :
Address :		Phone Number :
E-mail :		Date of Birth :

PLAYER # 2
Name :		Jersey # :
Address :		Phone Number :
E-mail :		Date of Birth :

PLAYER # 3
Name :		Jersey # :
Address :		Phone Number :
E-mail :		Date of Birth :

PLAYER # 4
Name :		Jersey # :
Address :		Phone Number :
E-mail :		Date of Birth :

PLAYER # 5
Name :		Jersey # :
Address :		Phone Number :
E-mail :		Date of Birth :

PLAYER # 6
Name :		Jersey # :
Address :		Phone Number :
E-mail :		Date of Birth :

PLAYER # 7
Name :		Jersey # :
Address :		Phone Number :
E-mail :		Date of Birth :

PLAYER # 8
Name :		Jersey # :
Address :		Phone Number :
E-mail :		Date of Birth :

PLAYER # 9
Name :		Jersey # :
Address :		Phone Number :
E-mail :		Date of Birth :

PLAYER # 10
Name :		Jersey # :
Address :		Phone Number :
E-mail :		Date of Birth :

PLAYER # 11
Name :		Jersey # :
Address :		Phone Number :
E-mail :		Date of Birth :

WAIVER INFORMATION EACH TEAM MEMBER MUST SIGN BELOW: I, the participant, hereby indemnify, save, protect, and hold forever harmless Gracedale Sports & Entertainment, Inc., its officers, directors, employees, stockholders, partners and agents (collectively "GSE") from and against any and all injuries, liabilities, obligations, claims, penalties, losses, costs, damages, or expenses (including, without limitation, court costs and attorney's fees and expenses) for which GSE, or any of them, may become liable by any reason of or in connection with or related to the Participant participating in the World Cup of Flag Football Open Tournament (February 20 - 24, 2002 at the Dolphin's Training Facility and Bamford Sports Complex), including, without limitation, those of bodily injuries, illness, death, or property damage. In case any action, suit, or proceeding is brought against GSE, or any of them, by reason of the occurrence of any of the forgoing events, Participant will a the Participant's expense, resist and defend such action, suit or proceeding, and cause the same to be resisted and defended by Legal Counsel approved by GSE, but GSE shall not unreasonably withhold it's consent. 1)   2)   3)   4)   5)   6)   7)   8)   9)   10)   11)         Date form signed by all team members: _____ / _____ / 2001

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