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2005 rego

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									Miranda Soccer Club Summer Soccer Rego Form 2005
                                                                                     2005 Winter Club
  Name        DOB   Phone no.   Address   Email Address (very important)   Student      and Grade
  Contact 1                                                                 Yes/No


  Contact 2                                                                 Yes/No


                                                                            Yes/No


                                                                            Yes/No


                                                                            Yes/No


                                                                            Yes/No


                                                                            Yes/No


                                                                            Yes/No


                                                                            Yes/No


                                                                            Yes/No


                                                                            Yes/No


                                                                            Yes/No



Please fill out electronically and email to info@mirandamagpies.com
by the 12th of August

								
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