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Coaches Name*
Address*
Address*
City*
State*
Zip*
Email*
Team Name*
Phone*
Cell Phone
Adult Division
Co-Ed
Church
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Seniors
Womens
Questions/Comments
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APPLICATION FOR MEMBERSHIP
Adult Team Registration -
$25.00
Please send payment to Andy Dooley -
7938 West Lynchburg-
Salem Turnpike, Thaxton, Va 24174
Registration will not be posted until below Registration Form has been completed!