Name:____________________________ Grade Entering:_________

Address:_____________________________________________

Phone number:______________________ E-mail:______________

T-shirt size:    S M L XL XXL         Emergency Contact:___________________________

Medical Conditions?:_____________________________________________

Parent signature:_____________________________________________

Method of payment - cash or check - made out to Lady Arties Basketball - c/o Vince Cerbone ($100)

Mailing Address: c/o Vince Cerbone
                                Martinsville High School
                                1360 East Gray St.
                                Martinsville, IN 46151