c k. Ap p ro p ria te. B o x. (e s). League Fees for Basketball: UCSF Student ... To Register: Deliver This Form To Any
Date & Time :
Fitness & Recreation
Staff Initial:
Fall 2017 Registration
**Please Fill Out Both Sides**
Registration Period: September 6 – September 17, 2017 Students and Members: September 6 – September 17, 2017 General Public: September 8 – September 17, 2017 Deadline For All Registration Forms: September 17, 2017 by 8:00pm. *Leagues are a first come first serve basis (max teams per league is 10) *A form of payment must be submitted with registration form *Free Agents are not guaranteed a spot on a team
Personal Information
All Fields Are Required Captain !
Please Check All That Apply:
Team Member !
Free Agent !
Team Name_______________________________________________ Name_____________________________________________________________________________________________ Address ________________________________ City ___________________________ Zip________________________ E-Mail _______________________________________________________
Date of Birth ______________________
Phone # (Day) ______________________________ (Night) ________________________________________________
Pricing
Leagues: Check Appropriate Box(es)
Parnassus Leagues
- league games begin 10/2/2017 Basketball Volleyball ! MON. Intermediate (0017.201) ! WEDS. Co-Ed Beg/Int. (0020.201) ! TUES. UCSF Students Only (0017.202) ! THURS. 6ft & Under (0017.203) Futsal ! SUN. Int/Adv. (0018.201)
Mission Bay Leagues - league games begin 10/2/2017 Basketball ! TUES. Beg/Int. (0017.251) *now accepting first 20 teams ! WEDS. Beg/Int. (0017.253) ! WEDS. Intermediate (0017.252) ! THURS. Advance (0017.254) ! THURS. Women’s Int. (0021.251)
Volleyball ! MON. Co-Ed Beg/Int. (0020.251)
League Fees for Basketball: ! UCSF Student & Member $64.00
! UCSF Employee & General Public $83.00
League Fees for Volleyball: ! UCSF Student & Members $56.00
! UCSF Employee & General Public $72.00
Member # ______________ I agree to pay the total amount stated on the right
Total # of Sign-Ups________ Total Due $___________ *MUST pay for AT LEAST 5 on roster
Card Holder’s Authorized Signature _______________________Name As It Appears On The Card (Print) ______________________
!- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Payment Information: Make checks payable to UC Regents. UC Reciprocity does not apply to Recreational Sports programming. Type of Card: ! Visa ! MC Card Number: Please Print Clearly
! Amex
! Discover Expiration Date
3-Digit Security Code
Date & Time : FOR OFFICE USE: Date: ________
Fitness & Recreation
Staff Initial: Checked By: ________
Receipt # ___________
As Captain I understand: 1. The priority sign-up procedure and the eligibility policy. 2. All my participants must be eligible and pay the appropriate individual fee (see roster). 3. It is my responsibility to obtain schedules, playoff information and inform my team of standards and rules. This information is available at
www.recsports.ucsf.edu 4. 5.
My team will abide by the Recreational Sports Spirit of the Game. If my team must forfeit a game, I must give a 24-hour notice to Recreational Sports to avoid the $30 forfeit fee.
Team Roster **All sections must be completed for entry. Students: Please list schools ((D) Dental, (P) Pharmacy, (M) Medicine, (N) Nursing, (G) Grad School, (PT) Physical Therapy) and st nd rd, th current year (1 , 2 , 3 4 ) in the “Student Only” section. Participant’s Name
E-mail or Phone (optional)
Gender
1.
M
F
2.
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F
3.
M
F
4.
M
F
5.
M
F
6.
M
F
7. 8.
M M
F F
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F
10. 11.
M M
F F
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F
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F
14. 15.
M M
F F
Student (S), Members (M), Employees (E), Gen Pub (GP)
Student Only
Fees
Total Due $________
To Register: Deliver This Form To Any UCSF Fitness & Recreation Service Desk Via:
**Registration forms are NOT accepted via email US Mail/ Campus Mail or Drop Off: Millberry Fitness & Recreation Center UCSF Recreational Sports 500 Parnassus Ave – Service Desk Level 1 S.F. CA 94143 – 0234
Bakar Fitness & Recreation Center UCSF Recreational Sports 1675 Owens St., Box 3000 S.F. CA 94143 – 3000
*Note: We accept registration forms via fax. Attn: Recreational Sports 415.514.4580
** Please call the recreational sports office for confirmation of league entry Recreational Sports office: 415.514.4581 or email us at
[email protected] 