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NAME OF PLAYER NO Please print PLAYER PLAYER SIGNATURE AGE FEE For LVSSL Use Only Form Received Date FEES RECEIVED Team Reg Player Reg Changes Forfeit to LVSSL 25 Time Other Total to LVSSL LESS Forfeit paid by LVSSL to opponent NET A player whose signature does not appear on this roster is not eligible to play for this team. Should such a player participate in a game that match may be forfeited and the team be fined 50.

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