UNIFORMS

Player Name:___________________________________________

Team:  Grade Group ___________Head Coach_________________

Number: 1^st choice_____2^nd choice______3^rd choice_____

Please Circle one:

Jersey Size:    YL       AS       AM      AL       AXL     AXXL

Shorts Size:    YL       AS       AM      AL       AXL      AXXL

Y= youth         A= adult

PAYMENT PLANS:

CT BREEZE  payment plan for 2012:

1.            Payment #1 of 50% due NO LATER than 12/15/2011

2.      Payment #2 of 50% balance due NO LATER than 1/15/2012

3.    or payment in full by 12/15/2011

**Failure to meet either due date will result in losing your place on the CT Breeze team**

Player name____________________________  Address________________________________

Town_______________________     Zip____________   Phone #__________________________

Date of Birth_________________________    Grade_______________________

Email___________________________________________________

Team:___________________________________________________

Amount:_________________________________________________

Check #:_________________________________________________

Please fill out this form and mail to:  CT Breeze, 628 East Main Street, Branford, CT  06405

Phone number:   1-203-494-8510