PRUMC

Please print and mail, fax or drop off to:

Peachtree Road United Methodist Church, Sports, Recreation, & Life Enrichment

3180 Peachtree Road NW, Atlanta, GA 30305, (404) 266-2386, Fax-(404) 266-0063

PRUMC Adult Basketball League Team Roster

Team Name: ____________________________________________________

Name Wk Phone Cell Phone Email Address

1. (Captain)

2.(Co-captain)

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Mark Payment Type: ____ Cash ___Check (pay to PRUMC) ___Credit Card: Visa or MC Amount: _________________

Card/ Check #: _____________________________________________ Card Exp. Date: ______ / ______ Today's Date: ____________

Name on Card: ______________________________________ Signature: _____________________________________

	Name	Wk Phone	Cell Phone	Email Address
1. (Captain)
2.(Co-captain)
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