Millersville University - Marauders Kids Club Registration Form

Black and Gold Club

Intramurals

Marauders Kids Club Registration Form

Marauders Kids Club *
Last Name *
First Name *
Age *
Address *
City *
State *
Zip Code *
Primary Phone Number *
Alternate Phone Number
E-mail Address *
Birthday *
Child's T-Shirt Size *
Parent/Guardian Contact *
By signing up to the Marauders Kids Club, you agree that Millersville University may use photos containing club members for university's promotional purposes.
Photo Agreement *	I Agree
Method of Payment
Payment Type *

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Millersville University is an Affirmative Action/Equal Opportunity institution;
a member of the Pennsylvania State System of Higher Education

Millersville University
PO Box 1002
1 South George St.
Millersville, PA 17551

Phone Number (717) 872-3011

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