Fall Flag Sign-up Form

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Player Name *

First

Last

Town or School *

New Player *

Yes No

If new player who referred you? (Needed to qualify for raffle) *

Gender *

Boys Girls

Shirt Size *

Grade Sept 2017 *

Please list names of friends that you would like to play with. Remember we can only put so many friends per team. *

Parent Name *

Parent Phone *

Parent Email *

Can we use your child's picture in our social media and website? *

Yes No

Parent help is very important to the success of the program. Would you like to coach? *

Yes No

Select One: *

I’m mailing full payment of $125 I will complete the PayPal/Credit Card transaction after I submitted the form $125

Make Checks Payable to: NEB
Mail Checks to: NEB, PO Box 1336, Plaistow, NH 03865

Note: Submit the form to complete and or proceed with PayPal/Credit Card secure payment on the next page.

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978-807-6714