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CSSA 2012 Registration Form

Complete the registration form below, print it, complete it, and mail it with your check to
CSSA
Lacy Lusk, League Treasurer
901 Buford Oaks Circle
Bon Air, VA 23235

Also, remember to Register to get access to the rest of this web site.

 

CSSA 2012 Registration Form

Complete this form, print it, and mail this form with your check to the address below
Registration Form
Name
Birth Date
Address
City
Zip Code
Residence(County or City)
Home Phone
Work Phone
Cell Phone
Email
 
Check if you will allow other players (but not the general public) to view your phone
Mens League (Check One)
H

 
Co-ed League (Check One)

 



Form Deadline for registration (for returning members to sign up for the teams on which they played last year) is March 1, 2012
*** IMPORTANT ***If your fee and form have not been received by the deadline, you WILL be placed in the player pooldraft
FEES
  Before June 30 June 30 and after
Co-ed League (Women 40+, Men 50+) $70 $70
1st Year CSSA Player (Women and Men) $70 $50
Mens League (50+) $70 $70
Non-resident of Chesterfield County (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

 

THE CHESTERFIELD SENIOR SOFTBALL ASSOCIATION IS A VOLUNTARY PROGRAM. I DOHEREBY WAIVE, RELEASE, ABSOLVE, INDEMNIFY AND AGREE TO HOLD HARMLESS THE CHESTERFIELD SENIOR SOFTBALL ASSOCIATION AND ITS REPRESENTATIVES FORANY CLAIM ARISING OUT OF INJURY WHETHER THE RESULT OF NEGLIGENCE OR FORANY CAUSE AND DO FURTHER ASSUME THE RESPONSIBILITY FOR MY CONDUCT.
SIGNATURE: DATE:
Please complete the entire form above and enclose a check for the total amount due to: 
CSSA c/o Lacy Lusk
League Treasurer
901 Buford Oaks Circle
                Bon Air, VA 23235


Visit our web site at http://www.ChesterfieldSeniorSoftball.com