SportsPleX

SportsPleX
5447 Intrastate Drive
Fairborn, OH 45324
(937) 878-7270
info@splex.com
www.splex.com

Team Registration Form
Fill out this form completely, then press the "Submit Registration" button below.

Deposits (Non-Refundable) Required: $200
Please Note: Your registration is not valid until a $200 deposit is received by SportsPleX.

The team registration deposit may be charged to the credit card with a convenience fee of $10. If the team deposit is not received prior to the session registration deadline, the credit card will be charged the $200 + $10 convenience fee to validate the registration so the team may be scheduled.

Payment arrangements can be made by contacting SportsPleX at 937.878.7270.

Team Information

Team Name:
Club Affiliation (Youth Teams):
League/Age Group:
Division:

Select Session

Session:
Skill Level Desired:

Primary Contact Information

Alternate Contact Information

First Name:

Last Name:

Address:

City:

State:

Zip:

Primary Phone:

- -

Alternate Phone:

- -

Email:

Confirm Email:

First Name:
Last Name:
Phone:	- -
Email:
Confirm Email:

Payment Information

How Would You Like to Pay for this Registration?
Check/Cash Please charge my Credit Card the League Deposit $200.00 + $10.00 Convenience/Service Fee Please charge my Credit Card the Full League Fee + $30.00 Convenience/Service Fee
Session Fee:	$
Convenience/Service Fee:	$
Total Fee:	$
Amount Paying Now:	$

Credit Card Information

Credit Card information must be entered in order to register. Your card will only be charged if you selected to charge the credit card above. If full payment has not been received by the identified Full Payment Due Date published on the SportsPleX website, the credit card will be charged for the payment due as well as a late fee of $35.00.

Type of Credit Card:	Visa Master Card Discover
Credit Card Number:	Do not enter spaces or dashes.
Expiration Date:	/
Card Holder Name:
Card Holder Address:
Card Holder Zip:
CSV Code (on back of card):

Please click ONLY ONCE on the Submit button above.
Sometimes, it takes a few seconds for the form to be processed. Thank you.