Total:
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Payment Authorization Form
Name
Team or Company Name
Team Gender
Boys
Girls
Team Age
8U
9U
10U
11U
12U
13U
14U
15U
16U
18U
Team Level
A
AA
AAA
B/House
House Selects
Email
Phone
Address
Tournament(s) you are attending
I authorize this payment
78
100
200.00
250
350
400
450
500
550
720
735
750
785
795
800
850
875
900
970
1000
1047.50
1050.00
1162.50
1195
1242
1300
1350
1395
1495.00
1585
1550
1570
1595
1695
1895.00
2305
2295
2890
4040
947.00
$4085.00
$2990.00
$747.50
$1995.00
$45.00
$445.00
$2542.50
$847.50
$2590.00
$4785.00
Signature
Clear
SEND
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