0 S A Regstratrant No

F~rstName

Last Name

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Address

Apt No.

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City 1 Town

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Area Code

Prov~nce

Telephone No

Date of
Birth

L L U - u

Postal Code

l
Month

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Sex OW)

Year

I
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u
Date Subrmtted to
ReleaslngClub

Day

Month

Year

1 I I I I I I I I

Player's S~gnature
Team Number

Team Name

ITIUU
League Number

:u
uu
5 ClubNumber
:Lclsl w u
&

D~stnctNumber

C4

League Name

I I I I I I I I I I I I I I I I I I I I I I
Club Name

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I l l

hstnct Name

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1 I I

Team Age Divlsion

I I 1

I l I l l 1 l l l l l l l l l l l l l l l l l l l l l l l l l

I
Team Gender

ale

emale rm m e d

0
0,

Recreational Amateur

Compet~tiveAmateur

!z

Date
Name of Club Remstrar
Team Number

uu
.;ILIu u
!ITI

Signature of Club Reg~strar

League Name

ClubNumber

Club Name

L l l LU
Dstnct Number

$ IDITJ

Mynth,

Ye7

I 1 I I I I I I I I I I I I I I I I I I l l l l l l l l l l l

League Number

2~
h

Professional

Team Name

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Non-Amateur

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Dlstnct Name

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I I I I I I I I I I I I I I I I I I I 1 1 1 1 1 1 1 1 1 1 1 ~

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Team Age I)lvlslon

Team Gender

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emale m~

ed

0
4
Y

0 Recreational Amateur

Compehnve Amateur

Non-Amateur

Date

Name of Club Registrar

. ct
b-

:r

3Z-nIZ7

Ljay

Mcinth,

Yer

Signature of Club Reg~strar

Association: When the receiving district is different from the releasing district, the receiving district is
=r rFho:xopy the transfer form, after district authorization, and send copy to the releasing district.

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Professional

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