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2014-15 Rebel Starzz Registration Form

Thank you for your interest in the UNLV Rebel Starzz. Space on the team is determined based on your date of registration (first-come, first-served basis).

To complete your registration for this season, you MUST complete the below three steps.

Step One: Complete this online registration form.
Step Two: Send your $35 registration fee payable to MMG Marketing to Rebel Starzz, 2784 Culloden Ave, Henderson, NV 89044 within 10 days of your online registration.
Step Three: Additionally send your $70 August monthly payment to MMG Marketing to Rebel Starzz, 2784 Culloden Ave, Henderson, NV 89044.

No space is confirmed until receipt of payment.

Form must be filled out completely

Participant Name:

Parent Name:

Age as of August 20, 2013:

Birth Date:

2013-14 Grade Level:

Home Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

Email Address:


T-shirt Size:

Who were you referred by:

Would you like to be a Team Mom?
YES
NO


Which group have you selected?*

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