REGISTRATION FORM
2012 Midnight Madness @ Bridgeview Sports Dome
Team Registration Information:
Organization / Team Name: _____________________________________________________
Managers Name: ____________________________
Address: ___________________________________ City: __________________________
Telephone #: ___________________________E-Mail Address: _________________________
Division Level Information: (Circle One)
10u 12u 13u 14u 16u 18u
Date Requested: (Circle One)
Nov 19th (13u / 14u) Dec 3rd (12u) Dec 10th (13u) Dec 17th (18u)
Jan 7th (13u / 14u) Jan 14th (16u) Jan 21st (12u) Jan 28th (13u)
Feb 4th (13u / 14u) Feb 11th (16u) Feb 18th (12u) Feb 25th (13u)
Registration Fee Information:
Total Dates Selected (_____) x $350, for a TOTAL of : $___________
Check # / Money Order #.………….........………………. ___________
Please fill out this registration form and mail it along with a check made payable to
SW Chicago NSA for the total amount. All registration forms accepted will be by post
marked date. Tournament entry will be on a first come first serve basis. Slots fill fast, so
get your entry in quick!
South West Chicago NSA Director
Fred Valdez
7757 S. Stickney
Bridgeview IL, 60455
We also would appreciate a confirmation reply to the following email address
valdeznsa@yahoo.com. Please state your intent on joining us, along with a confirmation
that you have mailed your registration form and payment.
Signed:___________________________________________ Date: ___________________