Registration

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BLAZER YOUTH SPORTS ASSOCIATION

                                            2009 BASEBALL / SOFTBALL PLAYER REGISTRATION

                              224 E. WALTON ST. BACONTON, GA 31716 (229) 343-1457 or (229) 344-6417

www.bysa.rec.tripod.com

email: bysa.baconton@yahoo.com

               PLAYER INFORMATION

* PLAYER'S BIRTH CERTIFICATE NAME:

(A copy of the player's birth certificate must be submitted with the registration form)

(First) (Middle) (Last)

* PLAYER'S DATE OF BIRTH:

* PLAYER'S AGE ON 04-30-2009:

AUBURN, AL (August 10, 2005) - The Dixie Youth Baseball Board of Directors unanimously adopted a change in the league age determination for its players beginning

with 2006 season. Beginning in 2006, the date in all divisions of Dixie Youth Baseball will be April 30 of the current calendar year.

* PLAYER'S RESIDENTIAL ADDRESS:

* PLAYER'S SCHOOL ATTENDED: SHIRT SIZE

* PLAYER'S SCHOOL GRADE: Youth Small

Youth Medium

* PLAYER'S GENDER: MALE OR FEMALE Youth Large

Adult Small

* PLAYER'S HOME TELEPHONE: Adult Medium

Adult Large

* PLAYER'S EMAIL ADDRESS:

REGISTRATION FEE: $40.00 PER PLAYER

The fee includes a team hat, team shirt and player insurance. Players keep the hat and shirt.

Players are required to supply their own pants, gloves, shoes (non-metal), and other personal

playing items. Insurance is supplemental to players with existing coverage and primary to players with no coverage.

Please attach a check or money-order to this form. This application may be mailed to

224 E. Walton Street, Baconton, GA 31716.