


| Team Name: | |
| Manager/Contact: | |
| Phone Number: | |
| Mailing Address: | |
| Email Address: | |
| Fax Number: | |
| Cell Phone Number: | |
| Check Number: | |
| Entry Fee Amount ($500.00) | |
| Make Check Payable To: | Walsh Memorial Classic In care of Jon Adams 815 N. Sherman St. Allentown, PA 18109 |










