Name:

Street Address:

Town:

BethpageFarmingdaleMassapequaSeafordOthers

State: NY ZIP Code:

Cell phone (so we can call/text):

How did you hear about us (Referral):

SelectFacebookFriend/League MemberFlyerOTHG WebsitePosted BannerPatchTwitterOther

When did you last play softball in a league:

SelectLast year2 years ago3 years ago4 years ago5 years ago6-8 years ago9-10 years ago11-13 years ago14-15 years agoMore than 15 years ago

What position do you prefer:

SelectPitcher - 1Catcher - 2First Base - 3Second Base - 4Third Base - 5Shortstop - 6Left Field - 7Left Center Field - 8Right Center Field - 9Right Field - 10

Are you a free agent for a team

Select TeamNot a Free AgentBar-BoyBethpage PharmacyBK SweeneysChanging TimesDantona IndustriesLittle LoungeLotusMcCourt & TruddenPiazzettasSal's PlaceStanley SteemerGrexicana

*(A manager will have told you if you are a free agent)

Date of Birth:

Month: SelectJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Day: Select12345678910111213141516171819202122232425262728293031

Year:  Select19831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952Pre 1952

Email Address:

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