Registration Form
The tournament is open to anyone, min. 14 years old, who registered before November 9:
Petanque America reserves the right however to decline participation at its sole discretion.
Each team appoints a captain, who is responsible for registration and payment.
- print out this page, and send it to us by fax and/or mail (you can also use this PDF-file)
- or register and pay online
Participation is not confirmed until your payment is received.

Player I - Captain

Player II

Name (First, Last):

Name (First, Last):

Address:

Address:

City, State, Zip, Country:

City, State, Zip, Country:

E-mail:

E-mail:

Phone:(day)                    (eve)

Phone:(day)                (eve)

Fax:

Fax:

Member US Petanque Federation:  yes / no

Member US Petanque Federation: yes / no

Participation

 If paid on or before Sept 30:  $ 20 x 2 = $ 40.00 per team
 As from Oct 1:                     $ 30 x 2 = $ 60.00 per team

 Enclosed is check #                      for $ _______

 Charge $ ___  to Credit Card below:

I will call in my Credit Card #

 Visa - M/C - Amex # : 

 Expiry Date:

 Name on card:

We acknowledge that our contribution for the tournament will not be refundable after November 1, that the tournament will be played by the rules of the US Petanque   Federation (FPUSA), and that any decisions by the referees will be final and not open for discussion.

 Signature of the Captain and date:

Ph:   800-682-2557
Fax: 305-592-4104
PetanqueAmericaOpen@Gmail.com