registration

	Hendu's Road Trip
	Welcome to your field of dreams!!
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	This IS NOT a secure web page, please do not attempt to submit your credit card information here at this time. These fields are here for you to enter your information to fax or mail this page in. You may print this page after filling out all fields and mail it with a check to: Dave Henderson Baseball Adventures PMB 2214 10002 Aurora Ave. N Seattle, WA 98133

		You may also fax this completed form with credit card info to (206) 417-2555

You may also call us to register at (206) 227-2555

Name:
Date of Birth:		Age:
Address:		State:
Day Phone:		Zip:
Evening Phone:
Email:
Height:		Weight:
Waist:
Uniform (suit) size:
Desired uniform #:

Camp Deposit (non-refundable) $200.00

Full camp balance due by August 31

There is a late fee after August 31 of $250

Full camp price is $996.50

Charge my credit card in the amount of $	Visa MasterCard
Card Holders Name
Card Number:	Exp Date:
By typing your name here you agree to this is in lieu of your signature and you will abide with all bankcard rules and charges:

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