General Information
Name Age   Birth date
Home Address
City   State    Zip    Phone (H)
Emergency contact Phone Relationship

High School & College/Open Players Only
Field Position   Graduation Year School 
Years Experience    Varsity   1 2 3   Junior Varsity  1 2 3  Club Experience  years
Mother's Name Phone Work Cell
Address
Father's Name Phone Work Cell
Address
email

Umpires Only
I will be  renewing my present rating  upgrading my current skills   trying for a rating
My current rating is Umpiring Association
I presently umpire: High School   College   Club   International

Coaches Only
I will be attending  Level I Certification    Auditing the course
I presently coach: High School   College (I, II, III)   Other  

Camp Fees  (Please make checks payable to US Field Hockey Association)

• all participants must be current USFHA members
  USFHA Membership #
  Exp. Date
• High School/Collegiate Camps are resident camps only
• Refund policy - Upon early withdrawal (up to two weeks before camp begins), all money will be refunded except $75. Withdrawal notice must be sent in writing to the USFHA National Office. No refunds will be issued during the 2 weeks prior to camp or after unless sent to the National Office and accompanied by a valid excuse from the participant's doctor. No exceptions.

$485