POTOMAC VALLEY BASKETBALL  ROSTER / REGISTRATION FORM.    
Fax to Ron Burks at 301-249-3371

 

   Team Name ____________________________Age Division_________________

Head Coach _________________________________

 

    Coach Contact Numbers __________________________________________

Coach Email _____________________________________

 

   Team Contact/Manager ____________________________________

Phone # _______________________Email_____________________

  

   Event Name (Tournament or League)_____________________________________________

 

       ROSTER -NOT TO EXCEED 15 PLAYERS                             

	Jersey # LT. # / DK #				TYPE NAME NAME (LAST, FIRST)		DATE OF BIRTH	GRADE EXCEPTION Y/N		SCHOOL ATTENDING
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