No Value Purchase
| REGISTRATION INFORMATION | |
| First Name: | Dan |
| Last Name: | NewLA |
| Email Address: | dan@libertyconcepts.com |
| Street Address: | 2 Test St. |
| Address Line 2: | |
| City: | Jamaica Plain |
| State: | MA |
| Zip Code: | 02130 |
| Phone: | |
| MEMBERSHIP PACKAGE | |
| Membership Options: | Opportunity Membership: $40 |
| Additional Opportunity Membership: ($40) | |
| Additional Basic Membership: ($20) | 5 |
| T-Shirt Size Selection: sml: med: lrg: 1 xl: xxl: xxxl: |
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Enter your order total below and click the Google Checkout button to complete purchase.
Alternatively, you can mail a check or money order to: Street Soccer NYC, 5 Hanover Square, NY, NY 10004
Please print this page and include it with your check. Your order will processed when your check is received.
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