Club Name : _______________________________

     Club Representative :___________________________ Email Address ________________________

     Mailing Address: __________________________________________________________________

      Telephone :Daytime :_______________________Evening:___________________

      Fax number:____________________

      Number of Teams you would like to register: _______

      Name of Team :___________________________________

     Coach's Name: ___________________________ Email Address ________________________email address:

     cellphone :____________________

Additional Teams to enter :______________________________________

                                        _______________________________________

                                       ________________________________________

Please mail and make your cheques payable to :  Liberty Aces Volleyball Club

                                                Attention : Marie Zamboanga

    268 Seaview Ave

         Jersey City, NJ 07305

To pay by credit card please call Marie @ 201-723-8851