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Peachtree Road United Methodist Church, Sports, Recreation, & Life Enrichment 3180 Peachtree Road NW, Atlanta, GA 30305, (404) 266-2386 |
PRUMC Adult Basketball League Team Roster
(Roster must be accompanied by
Individual
waivers for each player)
Team Name: ____________________________________________________
| Name | Wk Phone | Cell Phone | Email Address | |
| 1. (Captain) | ||||
| 2.(Co-captain) | ||||
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Mark Payment Type: ____ Cash ___Check (pay to PRUMC) ___Credit Card: Visa or MC Amount: _________________
Card/ Check #: _____________________________________________ Card Exp. Date: ______ / ______ Today's Date: ____________
Name on Card: ______________________________________ Signature: _____________________________________