Summary: NAME:
ADDRESS:
City, State, Zip
Cell Phone
E-mail Address
Age Grade (fall 2012)
HT Pos
Parent/Guardian(s) name
Work #
Emergency #
Roommate:
Insurance carrier
Policy Number
Jersey Size (circle) : S M L XL
Circle applicable option:
$100 deposit Payment in full $425
Mail with Check or money order payable to:
Elite Basketball Camp
475 Pine Cobble Road, Williamstown, MA 01267
The undersigned parent or guardian understands that applicant will be

Source: Aalberts, Daniel P. - Department of Physics, Williams College

Collections: Physics