Name _______________  School/Team______________________________
Address_______________________________________________________
Phone______________    Age _____

e-mail ______________________________

__Morning Session ___ Afternoon Session (please check one)

__ Field Player     __ Goalkeeper (please check one)
T-shirt Size (adult)   S    M   L       XL      XXL
Please make checks out to Travis Bishop.
Please mail registration to:                             Hands-On Soccer Academy
                                                                    c/o Travis Bishop
                                                                    2345 Oakleaf Drive
                                                                    Roanoke, VA 24017

Your registration is NON-REFUNDABLE!!