Tryout Registration Thank you for you interest in our Runnin’ Rebels program. Please complete the form below to register for tryouts. If there are problems, contact Mike Harris at runninrebels15@gmail.com 2019 Rebels Tryout Registration Form Player's Name* First Last Date of Birth* MM DD YYYY Gender*MaleFemalePlayer's Current Grade*Player's Uniform SizePlayer's Desired PositionPlayer's Email Player's PhoneFavorite college or pro player*Years as a Rebel*1st Year to #RebelUp2nd Year to #RebelUp3rd Year to #RebelUp4th Year to #RebelUp5th Year to #RebelUpParent Name First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Parent Email* Parent PhonePayment* $25 for one player, $50 for two players, $75 for three playersCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name
