Louisville
Slugger
2004
NSA GFP EASTERN "A" World
Series -
Columbus,
Ohio
Official
Entry Form and Team Information Sheet
Entry Deadline: July
13th, 2004
Please Print or Type:
Name of Team:
________________________________________________________________
Age Group: ___________
10u / 12u / 14u /16u /
18u
NSA
Classification:_A_
2004 NSA Sanction/Registration Number:
______________________________________________
Name of Insurance
Company: _________________________________________ Policy No. ___________________________
City
Team is From-City: _________________________________________________________
State: ___________________
Manager’s
Name:
_____________________________________________________________________________________
Managers
Mailing Address:
_____________________________________________________________________________
City:________________________________________________________
ST:_____________ Zip: ___________________
Daytime
Phone: (___________) _________________________ Evening Phone: (___________)
________________________
Email: ______________________________________________ Cell Phone: (_____________) _________________________
Additional Contact
Person Name:
___________________________________________________________________________
Phone:
(______________) ____________________________ Other Phone: (__________)
___________________________
Hotel where
you are staying: ____________________________
City:______________________________
Local Phone
for Hotel (NOT the 800#): ___________________________________ # Rooms Booked:
______________
ENTRY
DEADLINE:
JULY 13th, 2004
All
information MUST be to your State Director no later than JULY 13, 2004
MANAGER-
PLEASE SUBMIT THE FOLLOWING TO YOUR STATE DIRECTOR.
1. This Form Completed
2. Your 2004 Official NSA
ONLINE Youth Roster - completely filled in, with all signatures.
3. Copy of your “Team
Insurance Certificate”
4. Entry Fee of
$300 in the form of Cashier's Check or Money Order payable to NSA
I understand as
Manager of this team that it is MY responsibility to insure that all of the
above information meets all deadlines
and requirements. I
understand that if my entry is late, incomplete, or missing information, it
may be returned.
I understand that NO players will be added to MY teams Roster at the
tournament site.
Manager’s Signature: _______________________________________________ Date:
____________________________
STATE DIRECTORS
DEADLINE –TOURNAMENT DIRECTOR MUST RECEIVE THIS INFORMATION IN OFFICE BY
7-15-04.
This
team has qualified for the above tournament, and has participated in my State
Tournament. I have verified this
teams
information, and I am including this tournament entry form, NSA Form #17, the
teams COMPLETED roster
with all necessary
signatures, copy of insurance certificate and Correct Break down of fees for the above
team.
I understand that NO players will be added to ANY roster at the tournament
site, for ANY reason.
State Director Signature
_______________________________________________________________ Date ______________
Day Phone (________) __________________________ Night Phone (_________) ____________________________
Upon Verification by
7-15-04, State Director will forward: This form, NSA Form #17, the Team’s
Roster
and Insurance with Entry fees to: NSA
- PO Box 723 - Somerset, KY 42502
Fax: 606-679-6957
Office: 606-679-6545
CONTACT THE TOURNAMENT DIRECTOR FOR Next Day Address if needed: