Team Name ______________________ from (what town) ______________________


Team Captain _________________________ Captain's E-mail ____________________ 


Captain’s Street Address ________________________________________


           City_____________________ State________ Zip Code______________


           Home Phone # ______________________ Work #____________________


Player #2 _________________________ Phone # _____________________


Player #3 _________________________ Phone # _____________________


Player #4 _________________________ Phone # _____________________


Player #5 _________________________ Phone # _____________________

Circle One    $100-Pro Division        $100-Semi-Pro Division

Check or money order ONLY payable to: NJWA, PO Box 7032, Trenton, NJ 08628

Credit Card Info Visa __ MC __ Amex __  Card #  __________________________ Exp ___

Please inlcude payment with this application

I, ____________________ captain of the ____________________ believe all the 
foregoing information is true to the best of my knowledge. If the above team is 
accepted to play by the NJWA, the team will abide by all the association’s rules 
and regulations relevant to play and good sportsmanship.

By: _________________________		Date: ____________________

If you received this application with an envelop that has your name and address
typed on a label you are on the NJWA’s mailing list, if you are NOT on the NJWA’s
mailing list please check the appropriate box. Please check one of the boxes below.

YES my team is on the mailing list ______ 

NO my team is not on the mailing list ______