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Los Gatos APJCC Mail In Registration Form

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Mail form to PSA, PMB #405, 1484 Pollard Avenue, Los Gatos, CA 95032

   
PLAYER NAME:  
ADDRESS:  
PLAYER AGE:     GENDER:     HOME PHONE:  
CONTACT EMAIL:  
 
CHECK : Tuesdays (APJCC)
 Wednesdays (APJCC) Saturdays (APJCC)    
  9:45 - 10:15 (3.5-4 yrs) 9:45 - 10:15 (3.5-4 yrs) 9:00 - 9:30 (3.5-4 yrs)    
. 12:30 - 1:00(3.5-4 yrs) 12:30 - 1:00(3.5-4 yrs) 9:35 - 10:20 (5-6 yrs)    
  3:00 - 3:30 (3.5-4 yrs) 3:00 - 3:30 (3.5-4 yrs) 10:20 - 11:05 (7-10 yrs)    
  10:15 - 10:45 (4-5 yrs) 10:15 - 10:45 (4-5 yrs)        
  1:45 - 2:15 (4-5 yrs) 1:45 - 2:15 (4-5 yrs)        
  3:45 - 4:30 (5-6 yrs) 3:45 - 4:30 (5-6 yrs)        
  3:45 - 4:30 (7-10 yrs) 3:45 - 4:30 (7-10 yrs)        
                 
                     
PAYMENT TYPE: VISA MC AMEX DISC CHECK (Payable to PSA, No Cash)

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NAME ON CARD:  
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CARD NUMBER:     EXP. DATE (mo/year):  
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BILLING ADDRESS :  
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Please contact Coach Mike with any questions.

(408) 378 - 3893
coachmikesoccer@yahoo.com
 
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