LA Galaxy Soccer Fantasy Camp

Date: December 9-13, 2009
Location: The Home Depot Center
Time: 9am - 4pm
Cost: $1195 (Registration cost is non-refundable)

Some of the highlights from previous camps include:
– Galaxy uniform with your name and number
– Play & train at The Home Depot Center state-of-the-art facilities
– Access to the Locker and Fitness rooms
– Daily Lunch with alumni Coaching staff
– Galaxy Fantasy Camp gift bag

TO REGISTER FOR THE GALAXY FANTASY SOCCER CAMP, PLEASE FILL OUT THE FORM BELOW. PLEASE REGISTER EACH CAMPER ON A SEPARATE FORM. FOR MORE INFORMATION OR IF YOU HAVE QUESTIONS, PLEASE CONTACT: BLANE SHEPARD AT (310) 617-4488 OR E-MAIL - BSHEPARD@LAGALAXY.COM

All fields marked with an * are required.

Step 1. Registration Information
Item Quantity Total
Galaxy Fantasy Camp Registration    1   $
TOTAL: $
Step 2. Player's Information
* Gender: Male   Female * Highest soccer level played:
* Years you have played soccer: * Requested jersey number: (Limit: 2 digits)
* Name to appear on jersey:
(Limit: 9 characters)		 * Jersey Size:
* Short Size:
* Position(s) you play:  Goalkeeper     Defender     Midfielder     Striker
League name: Team name:
* Emergency Contact Name: * Emergency Contact Phone:
* Primary Physician: * Primary Physician Phone:
Step 3. Billing & Shipping Info
Billing Info
*First Name:
*Last Name:
Organization:
*Address:
Address Line 2:
*City:
*State / Province:
*Zip / Postal Code:
*Country:
Shipping Info same as billing info
*First Name:
*Last Name:
Organization:
*Address:
Address Line 2:
*City:
*State / Province:
*Zip / Postal Code:
*Country:
Step 4. Payment & Contact Info
Payment Info
*Name on Credit Card:
*Credit Card Number:
*Credit Card Expiration:
*Credit Card Type:
Contact Info
*Evening Phone:
Mobile Phone:
*Birth Date:
*E-mail Address:
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No exchanges or refunds; not valid with any other offer. Subject to availability. All sales are final.