Membership Form

Name: ______________________________    
Kids .
 Playing:    
Name: ______________________________
Age:
 ____
Name: ______________________________
Age:
 ____
Name: ______________________________
Age:
 ____
Address: ______________________________
 
City: ______________________________
 
State: ______
Zip:
 __________
Phone: _________________    
Cell: _________________    
E-mail: _______________________________    
(email will be used only for BLSA announcements/communications)    
 
Interested in helping with:
 ______ __________
 
Interested in being a coach:
 ______ __________
______
 Individual $10 ______ Family $15

Mail to: BLSA, PO Box 310, Basehor, KS 66007