Richfield Area Chamber of Commerce
             
Richfield Area Chamber of Commerce

 
Team Name
Commitment Deposit (non-refundable):   $50.00   Item Subtotal:  
$50.00
Team Entry Fee:   $200.00   Item Subtotal:  
$200.00
 
Total:
$250.00
 
Team Captain's Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
 
Payment Information
Method of Payment:
Processing Fees: Credit cards: 2.9% plus $0.30
eChecks: $0.55
Update name from Team Captain's Information
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number:
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Team Captain's Information
Cardholder's Name:
Billing Street:
Billing ZIP/Postal Code:
 

Informed Consent and Release: Important, this is a legal document, read carefully.  Each of us, the undersigned players/coaches, acknowledge, agree and understand to participate and hereby assume all risks of injury or loss incurred or suffered while and/or upon the premises of the City of Richfield and Richfield Area Chamber of Commerce, its agents, associates, employees or anyone connected with the City of Richfield and Richfield Area Chamber of Commerce may claim, damages, costs or cause or action which I have or may in the future have as a result of injuries or damages sustained or incurred while and/or upon the premises of the City of Richfield.  I the undersigned player/coach, acknowledge that I have read and understand the above.

 
I Agree
I have read and understand the Informed Consent and Release
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