Baseball Nevada

PO Box 50517

Henderson, Nevada 89016

702-435-7775

702-456-5966 fax

TOURNAMENT FEES

CREDIT CARD AUTHORIZATION FORM

THIS FORM COMES STRAIGHT TO MY HOME.

DATE: _________________

TEAM NAME: ______________________________

AGE GROUP OF TEAM: _____________

Early Registration must be meet prior to cut off date

Veteran’s Day Early Fee $ 450 (by Oct 17^th) Qty _____ x _______ = __________

Regular Fee $ 500 (after Oct 17^th) Qty _____ x _______ = __________

Cranberry Classic Early Fee $ 450 (by Nov 7^th) Qty _____ x _______ = __________

Regular Fee $ 500 (after Nov 7^th) Qty _____ x _______ = __________

MLK Tournament $ 500 Qty _____ x _______ = __________

Presidents Day Tournament $ 500 Qty _____ x _______ = __________

Easter Classic $ 500 Qty _____ x _______ = __________

Total Qty _____ x _______ = __________

TYPE OF CARD: (circle correct card) MasterCard Visa

CREDIT CARD NUMBER: ______________________________________EXP. DATE: _____________

NAME ON CARD: (PLEASE PRINT) __________________________________________

ADDRESS FOR CARD: _______________________________________________

________________________________________________

I HAVE AGREED TO PURCHASE ITEM WITH MY CREDIT CARD:

AUTHORIZED SIGNATURE: _____________________________________________

PLEASE FAX BACK TO : 702-456-5966