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Player Personnel Form

First Name

Last Name

Social Security Number

Date of Birth:

Address
City

State

Zip Code

Phone Number

Cell Phone Number

Email Address

Cell Phone Number

Email Address

Spouses Name (if applicable)


Phone Number

Emergency Contact Name

Phone Number

Agents Name
Address
City

State

Zip Code

Phone Number

Cell Phone Number

Email Address

State

Zip Code

Bank Name
Address
City
Direct Deposit

yes

no

Deposit Amounte4

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