DOMINICAN REPUBLIC WINTER BASEBALL TRIP PLEASE FILL OUT ONE FORM PER PERSON. "*" indicates required fields Information Required For Parents And PlayersIMPORTANT:To pay remaining balance click here: Remaining Balance Name as it appears on passport* Including any MIDDLE NAME OR INITIALSPassport number* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Cell Phone*Parent's Email Address* Date Of Birth* MM slash DD slash YYYY Sex* Male Female Golf Shirt Size (Adult)SMLXL2XL3XLPlayer InformationPosition(s) played Jersey Size & Number (Player Only) High School & Graduation Year Colleges you are looking at Payment InformationNon Refundable Deposit Price: Remaining balance Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name To pay by mail: Make Checks Payable To: Sal Agostinelli MLB Camp and Tournaments PDF of this form Dominican Trip 14 Ashland Drive Kings Park, NY 11754 Questions: info@salsbaseball.com or 631 979-0528
