MICHIGAN NSA  - TRAVEL PERMIT

DATE of Request:    

NSA Registration Number:

My team wishes to participate in the following NSA Tournament:
Tournament Name:    TRNY Date: 

Tournament Location:    Trny Director:

Please Select:    8u 10u 12u 14u 16u 18u 20u AGE   _____________and   A B CLASS ______________

 Team Name:

Manager Name:

Fax:   E-mail:

Phone: (H)     Phone: (W)
  I acknowledge that my signature as team representative verifies I will take an extra Copy of my Official NSA
  Online Roster, complete with all signatures AND an extra copy of my insurance CERTIFICATE to leave at the
  tournament site.  I understand that my team will not be allowed to participate without them.  I also understand
  that these copies will NOT be returned to me at any time.

  Team Representative's Signature: ________________________________________
Send copy to:   NSA  ·  P.O. Box 187 ·  Fenton, MI 48430   or   Fax: 810-629-2852

State OFFICE Approved Date: ___________________________  Approved By: ______________________
This form will be reviewed by the MI NSA State Office.  The Form will be forwarded to the Tournament Director.
After the Travel Permit is received in office, it will take no less than one week to reply.
After one week, please feel free to contact us via e-mail.  Thank you.