Player Registration – La Pine Lions Club

Player 1 (team representative) *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Choose One

After August 15: Individual - $110.00
After August 15: Team - $440.00

Player 2

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Player 3

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Last

Address

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Address Line 2

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State

Zip Code

Phone

Email

Player 4

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Email

Total

$0.00

Stripe Credit Card *

Card

Name on Card

La Pine Lions Club

PO Box 3241

La Pine, OR 97739

Email: lapinelionsclub@gmail.com

Website: https://www.lapinelionsclub.org

La Pine Lions Club Foundation is a 501(c)3 tax deductible organization

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