Today's Date ___________________________

Players Name ___________________________

Parents Name(s)____________________________

Home Address___________________________________________

Town__________________________________

Home Phone_____________________________

Cell Phone_____________________________

E-mail Address_____________________________

Players Date of Birth_____________________________

Do you Have Travel Experience? Yes___No ____

List Positions Played_______________________________

Registration Fee $20.00 (includes a practice shirt)
Pre-register Before August 1st Fee $15.00

ALL CHECKS MADE PAYABLE TO THE LONG ISLAND BANDITS
Mail to: Brian Torlincasi
               481 Bayport Ave
               Bayport N.Y. 11705
Email: btor@longislandbandits.org

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Administrative Tryout Fee $20

Please Print out and complete all applicable forms to expedite check in upon arrival