REGISTRATION FORM FOR RICHMOND BASEBALL ACADEMY
Print, fill out & mail/fax form for credit card or check registration.  

NOTE: A $50 non-refundable deposit is required to insure registration in 
the program of your choice. Checks, Visa and Mastercard are accepted.

Camp (ex. B-1 or W-5)

         Day, Time and Description (ex. Thurs 5-6:30 Minors HPF)


1st Choice___________

 _______________________________________

 $  


2nd Choice____________

 ___________________________________________________________

  $

 Annual Membership Fee. ($75 single/$100 family)

Single

Family

 $  

 $75.

  $100.

 CHECK ADULT T-SHIRT SIZE: 
 ___S   ___M  ___L  ___XL                                                          Deposit:

                                                                            TOTAL Amount Due: 
Player's Name:
_______________________________
Birth Date:
_______/_________/______________
Address:
______________________________
City:
______________________________
Zip:
______________________________
Email Address:
______________________________
   Home phone:
______________________________
Parent Name:
______________________________
Emergency
Contact Name:
______________________________
Emergency
Phone No.:
______________________________
     

CREDIT CARD INFO

Card Type:
  MasterCard   _____  or Visa   ______ 
Expiration Date: __________/ 20____
Card Security Code:
_____
[ 3 digit number found on back of your card]
Card #:
______________________________
___________________________________________
Signature of adult responsible for registration
 ___________________________________________
Signature of cardholder
West Location: Phone: 804-264-3648 (For more information or to place phone orders)
Fax: 804-264-5089 (credit card orders only) or e-mail us
Mail to: Richmond Baseball Academy, 8406 Sanford Dr., Richmond, VA 23228
South Location:  Phone: 804-743-1533 (For more information or to place phone orders)
Fax: 804-743-1554  (credit card orders only) or e-mail us
Mail to: RBA South, 2240 Oak Lake Blvd, Suuite 200, Midlothian, VA 23112
East Location:  Phone: 804-569-9515 (For more information or to place phone orders)

 Fax: 804-569-9528 (credit card orders only) or email us 
Mail to:  Richmond Baseball Academy, 8176 B Elm Dr, Mechanicsville, VA 23111
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