VFM On-Line Registration Form
Name:
Street Address:
Street Address:
City:
State:
Zip:
Telephone:
E-mail:
Date of Birth:
Sex:
How often do you practice:
Where do you practice:
How many meets do you enter:
Are you a USMS member:
USMS Registration Number:
What USMS team do you represent:
Any Comments or Suggestions:
Please send a check for $ 20.00 payable to "Valley Forge Masters" to:
Dan Castellano
20 Cabot Court
Media, PA 19063
484-444-0206
dcastell@bee.net