Team Name ______________________ from (what town) ______________________


Team Captain _________________________ Captain's E-mail _________________   


Captain’s Street Address ________________________________________


City_____________________ State________ Zip Code______________


Home Phone # ______________________ Work or Cell #____________________


Player #2 _________________________ Phone # _____________________


Player #3 _________________________ Phone # _____________________


Player #4 _________________________ Phone # _____________________


Player #5 _________________________ Phone # _____________________

TEAM ENTRY IS $100 

If Paying by Credit Card, CC# Type _______ CC# _______________________ Exp _____

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

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 ______