PRUMC

PRUMC Fall Basketball League - Team Roster
Please print (in Landscape) and mail, email or drop off to Peachtree Road United Methodist Church Sports & Recreation
3180 Peachtree Road NE, Atlanta, GA 30305 (404) 266-2386

Team Name: _____________________________________ (Circle One): Varsity / JV / Grades 6-8

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Circle payment type (Please Circle):   Cash     Check (pay to PRUMC)     Credit Card: Visa / MC

Amount: $700      Card/ Check #: ______________________________________ Exp. Date: _________

Cardholder Address (if applicable): _______________________________City__________ St____ Zip_______

Signature: ________________________________________________________Date: ____________

Insurance Liability Waiver must be signed for each player. Go Here: Waiver

Coaches	Name		Address	Phone Number	Email Address
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Players	Name	Date of Birth	Address	Phone Number	Email Address
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