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Application
(Print and Mail)
Price: $4,195.00
Camp Date:
____ February, ____ November
Name:
________________________________________________________________
Address:
________________________________________________________________
City:
______________________________________ State: _______
Zip:_________
Business
Ph: __________________________ Home Ph:
__________________________
Fax: _________________________________ eMail:
____________________________
Occupation: ___________________________ DOB:
____________________________
Soc.
Sec. No.: ________________________ Weight:
_________ Height: __________
Positions
I would like to play: 1st Choice:
______ 2nd
Choice: _________
Playing
Ability:
Good: ______ Fair: ______ Poor: _______ T-Shirt Size: __________
Suite Size: _____________ Waist
Size: _________ Preferred
Uniform No. ________
I
am a return camper and DO NOT need a
new home uniform: _____
______
Enclosed is my check payable to L.A. Dodgers Adult Baseball Camp
_____
Please charge the amount to my credit card:
____
MC ____ AmEx ____ Visa ____ Discover ____ Diners
Club
Amount to be Charged: ____ $500.00 Deposit ____
Other: $_____________
Card
Number: __________________________ Expire
Date: _____________
1. I
understand that if I cancel in writing prior to December 1, 2000,
I will receive a refund of payments made, less a $300.00
administrative cancellation fee. No refunds or transfers
will be made if I cancel after December 1, 2001.
2. I have
no knowledge of any physical impairment that would prevent me from
participating in the Los Angeles Dodgers Adult Baseball
Camp. I will send a letter from my physician indicating that
I am able to participate or I will sign a release of liability
upon arrival at camp.
3. I
authorize Dodgertown to act for me in any emergency requiring
medical attention. I understand that should I incur any
injury my insurance company will be the primary insurer and the
Dodgers Adult Baseball Camps limited medical insurance will be
secondary.
4. I
understand that Dodgertown retains the rights to any photographs
taken of adult campers during their stay at Dodgertown and that
photographs and other information may be used for publicity,
advertising and other promotions for the camp.
5. I agree
to indemnify and hold harmless the Los Angeles Dodgers, Inc. and
their owners, directors, officers, representatives, agents,
successors, and assigns, from and against any and all claims or
liabilities to me or anyone else for any injuries or illness
whatsoever including, without limitation to, injuries to my
person, and/or property, arising out of or incident to my
participation in the Los Angeles Dodgers Adult Baseball Camp.
6. Major newspaper in my area: _________________ Local
Newspaper: ________________
7. Other publications (association, college, university,
occupational): ___________________
8. I would
like to be roomed with ______________
I am a smoker: ____
Non-smoker: ____
9. I would like to participate in the talent show during
camp. My act is __________________
10. I have seen advertisements for Dodgers Adult Baseball Camp in:
____________________
11. I was
referred to the camp by Creative Edge Enterprises (Mark Stone) and
the Dodgertown West website.
Signature:
_________________________________________ Date:
_________________
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