Celtics Sign Up

Fill out the form below for our Celtics event on Monday, January 14, 2008! YOU CAN ALSO ENTER THE RAFFLE at the same time! Be sure all information is accurate before submitting the form. When you press Submit at the bottom of the form ONCE, an automatic form page will be generated for you.

You can pay online for your tickets (please add $5 to the grand total for the PayPal fee) or, you can print the form that will come up after you confirm your purchase and mail a check.

Once your payment is received, we will assign your seats - first come, first serve! The earlier you order, the closer your seats are! If you want to pay online we will assign your seats immediately but please add a $5 service charge to your total - thanks!

Norfolk Youth Basketball
Boston Celtics Event at the TDBankNorth Center
January 14, 2008 - 7:30 pm

Parent/Guardian Information:

Parent/Guardian First Name
Parent/Guardian Last Name
Street Address
City
State
Zip Code
Home Phone
Work Phone
E-mail

Tickets/Raffle:	Quan		Total
Game Tickets Lower Arena @ $75 ea		=
Raffle Tickets @ $5 ea (raffle for drawing for autographed basketball or tickets to a future game		=

*Total Amount Due:		=
*Required Field

Please add the names and ages of all who are attending if known

Please add any additional comments or information for us:

I certify that I am familiar with the contents of this release and that I accept any and all responsibility for, and assume the risk of any and all injuries to my child, which might arise either directly or indirectly as a result of his or her participation in these programs. I hereby express release, discharge, and hold harmless from any liability whatsoever, Norfolk Youth Basketball, Inc. as well as the employees and instructors in their private and individual capacities as they represent Norfolk Youth Basketball, Inc. whether salaried or voluntary.

Please type your name agreeing to above statement:

Be sure all information is accurate before submitting the form. When you press Submit, an automatic form will be generated for you.

Please only press the Submit Button Once - You may have to wait up to 1 minute for the form confirmation