Please print out the form, fill out all sections, sign it and do one of the following:

1) Fax to 1-888-397-2470. Please also include a photocopy of your driver's license
2) Mail it along with a photocopy of your driver's license to:
    Chowder Cup Tournaments
    PO Box 484
    Westwood, MA 02090



First Name:

Last Name:

DOB:

Address:

City

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Division:
Team Name:

Signature: