FOUR STAR LACROSSE BULLDOG CAMP
ONLINE REGISTRATION

Thank you for registering online for the Four Star Lacrosse Camps.  There are three steps left in the registration process:

Step 2: Fill out and Submit the form below.

Step 3: Pay the registration fee either on our secure online server or by mailing us a check.

Step 4: Fill out and send in your Medical Form, which will be e-mailed to you once you've successfully completed Step 2.

Camper Information
First Name		Last Name
E-Mail Address		Note: All future messages from us will be sent to this e-mail address.
Confirm E-Mail Address		Please re-type your e-mail address to confirm that it is entered correctly.
US Lacrosse Member No.
Address
City
State	none Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip Code
Phone
Age
Height	e.g. 4ft. 6in. (no 's or "s please)
Weight

Parents' Contact Info
Mother's Name		Mother's Phone
Father's Name		Father's Phone

School Info
School	Please Select Bethpage Calhoun Carey Clarke Cold Spring Harbor Division Ave East Meadow Elmont Farmingdale Floral Park Friends Garden City Glen Cove GN North GN South Hempstead Herricks Hewlett Hicksville Island Trees Jericho JFK Bellmore Lawrence Locust Valley Long Beach MacArhthur Malverne Manhasset Massapequa Mepham Mineola NH Park Oceanside Plainedge Plainview Port Washington Roslyn Seaford Sewanhaka Southside Syosset Uniondale VS Central Wantagh West Hempstead Wheatley Chaminade St Marys Kellenberg St Anthonys Holy Trinity St John Baptist Babylon Bayport Bayshore Bellport Brentwood Commack Comsewogue Connetquot Copaigue Deer Park East Islip Easthampton Eastport HHH East HHH West Harborfields Hauppauge Huntington Islip Kings Park Lindenhurst Longwood Mercy Middle Country Mt Sinai North Babylon Northport Pat-Medford Riverhead Rocky Point Sachem East Sachem North Sayville Shoreham-WR Smithtown Southhampton Stonybrook School Walt Whitman Ward Melville West Babylon West Islip Westhampton William Floyd Corning East, NY Foxboro, MA Toms River, NJ A. Spalding Freeport Old Mill OTHER Buffalo HS Albertus Magnus North Shore Fallston HS Xaverian HS Bishop Timon Hanover Park Mattituck Greenport Bryant	Other School
Grade in Sept '09	2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th
Position	ATTACK Att/Mid MIDFIELD Long-stick Midfield DEFENSE Goalie

Camp Info
Team Request		If you'ld like to join another school's team, please enter its name here.
Payment Plan?	Send me info.	Check here if you can't afford to pay the full Registration Fee on time. The Camp Director will contact you about setting up a Payment Plan.

Website User Info
By entering a Username and Password below, you will be able to log into the site later to view or update your registration info. Please keep this for your records.
Username
Password

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