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CSSA 2018 Registration Form

Complete this form, print it, sign it and mail this form with your check to the address below

THE CHESTERFIELD SENIOR SOFTBALL ASSOCIATION IS A VOLUNTARY PROGRAM. I DO HEREBY WAIVE, RELEASE, ABSOLVE, INDEMNIFY AND AGREE TO HOLD HARMLESS THE CHESTERFIELD SENIOR SOFTBALL ASSOCIATION AND ITS REPRESENTATIVES FOR ANY CLAIM ARISING OUT OF INJURY WHETHER THE RESULT OF NEGLIGENCE OR FOR ANY CAUSE AND DO FURTHER ASSUME THE RESPONSIBILITY FOR MY CONDUCT.
SIGNATURE: Date:         /        /2018
Please complete the entire form and enclose a check for the total amount due to:  
Chesterfield Senior Softball Association
PO Box 2713
      Chesterfield, VA 23832 


Visit our web site at http://www.ChesterfieldSeniorSoftball.com
Name
Birth Date
Residence Address
City
Zip Code
Residence
(County or City)
Home Phone
Work Phone
Cell Phone
Email
 
Check if you will allow registered members of the web site to view your phone
Mens League (Check One)
GOLD

SILVER
Headliners


 
Co-ed League (Check One)
Thunderbirds
Rookies




Form Deadline for registration (for returning members to sign up for the teams on which they played last year) is March 16, 2018

*** IMPORTANT ***If your fee and form have not been received by the deadline, you WILL be placed in the player pool draft
FEES
  Before June 30 June 30 and after
Co-ed League (Women 40+, Men 50+) $70 $70
Mens League (50+) $70 $70
 1st year CSSA players Women & Men $70 $50
Non-resident of Chesterfield County Men's League (in addition to the league fee) $15 $15
Non-resident of Chesterfield County Co-ed League(in addition to the league fee) $15  $15 
Total Due
All blanks are to be completed in order to be eligible for league play. You must ALSO sign at the bottom