| Registration Form Hitters Row Winter Baseball Camp Session 1: December 17, 2011 Session 2: December 21, 2011 Session 3: December 28, 2011 Session 4: December 29, 2011 Camper's Name: _______________Parents Name: _______________ Age: _____ Birthday:___________ Phone Number:_______________ Address:____________________ Second Number:_______________ City: __________State: ____Zip:______ E-Mail:___________________ Method of Payment Check:______Cash: Please pay at Hitters Row Baseball Academy Credit Card: __Visa, Master Card, Discover, & American Express Card Number: ____________________________________________ Expiration Date: __________________________________________ Billing Zip Code: _________________________________________ Name on Card: ___________________________________________ Amount Authorize to charge: _______________________________ Signature: _______________________________________________ Date: ___________________________________________________ Hitters Row Baseball Academy 1901-D 50th Street LUBBOCK, TX 79412 (806) 749-8448 www.hittersrow.com |