Lake Placid Payment – Tri-City Lacrosse, Inc.

Player Name *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Email Address *

Phone *

Program *Please choose which program/session player will be participating in.

Shirt and Jersey Size *

Jersey Number *Jersey Number

Shorts Size *Shorts Size

Payment Type *$150 due.

Check Number

US Lacrosse ID *E.g. 100532318 - Use www.uslacrosse.org to lookup/renew/create your Membership ID.

Accept Waiver *

I AcceptBy checking this box, you agree to the Tri-City Lacrosse liability waiver and will also ensure US Lacrosse Membership is valid through the end of the session.