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NORTH TAMPA BAY SENIOR SOFTBALL, INC. PLAYER REGISTRATION FORM – 2022-2023 SEASON____________________________PERSONAL INFORMATION___________________________Name:____________________________________________________________________________________ Last First Like To Be Called Address:__________________________________________________________________________________ Street Address ________________________________________________________________________________ City State Zip CodeContact Number(s)(HOME)_____________________________(CELL)_______________________________ ALREADY HAVEShirt Size: CIRCLE ONE:S MLXL2XL3XL2 SHIRTS?-CIRCLE – YES OR NO E-mail Address PRINT CLEARLY:______________________________________________________________Date of Birth:____________________________________ Age Today:________________________________First Emergency Contact:___________________________1st Contact Number:__________________________ If needed:Second Contact:__________________________________2nd Contact Number:_________________________Any extended away time planned? YES or NO. Dates or number of Fridays you may miss:_________________________________________________________________________________________________________If you are currently out of town, enter DATE you will be back in town to play ?____________________________________________________________PREFERENCES__ _____________________________What softball position(s) do you play? (Used for the draft): _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Signature verifies you have received, read, signed Player’s contract and/or Manager’s contract, Waiver/Release of Liability, provided proof of age, and 2022-2023 Rules Handout.CIRCLE: $60.00 dues - cash, money order, check (payable to NTBSS, Inc.) and/or mail to: Jeff Holden, 11434 Bathgate Ct., New Port Richey, FL 34654Player Signature:_____________________________________________ Date:_____/_______/___________FOUNDER-WALT BOCKMILLER
What is phase B in Medi-Cal?
