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Girls 7/8 �    Boys 7/8 � 

Team:

Phone:

Other Contact:

Phone:

Fax:

E-mail:

Team Color:

Mailing Address

Please list any special Needs:

Mail form and Check (payable to PYBA) to:  PYBA , PO Box 96, Potsdam, NY  13676
             ( Space is limited and teams will be accepted when payment is received)