b'REGISTRATION CAPTAINS SIGNATURE:______________________________________________________________DATE:_______________________ REGISTRATION DEADLINES: Registration forms sent through the mail must be received by the registration deadline indicated. all league rules and regulations at all times . my team and will follow GOOD SPORTSMANSHIP: As a captain I am responsible for my team. I will recruit players who display good sportsmanship. I will be the spokesperson forNOTE: YOU WILL NOT BE MAILED A WRITTEN RECEIPT. ASSUME THAT YOU ARE IN THE ACTIVITY UNLESS OTHERWISE NOTIFIED. Special Scheduling Request (not guaranteed) _________________________________________________________________________________________ FEE TEAM NAME SPORT LEAGUE BE SPECIFIC WORK PHONE PRIMARY PHONE _____________________________________________________________________________________________________________________ CITY, STATE ZIP ADDRESS _____________________________________________________________________________________________________________________ EMAIL CAPTAINS NAME _____________________________________________________________________________________________________________________ 3 DIGIT CODE ON BACK OF CARD AUTHORIZED SIGNATURE Credit Card # _______________________________________________________Exp. Date ______________________ CCV# _______________________________________________________________________________________________Method of Payment: Cash Enclosed ___________Check Enclosed ___________Make Checks Payable to City of KearneyVisa ___________Discover ___________ ___________ Mastercard RETURN COMPLETED FORM WITH FEE TO: Kearney Park and Recreation Dept., P.O. Box 1180, Kearney, NE 68848//Phone: 237.4644Voice/TDD 233.3215 FAST, REGISTER EARLY! MANY LEAGUES FILLadult league registrationOFFICIAL USE _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________TOTAL ___________________PG.38'