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LONGISLAND SUMMERSHOWCASECAMP
EXPLOREMOREAT
SURGEELITELAX.COM
MAIL TO:
128 POINTECIRCLESOUTH
CORAM,NY 11727
SURGEELITELAX@GMAIL.COM
KARA MUPO
AND
PRESENT
JULY 30TH
OPEN TOANY AND ALLHIGH SCHOOLGIRLS
GRADUATINGIN 2018-2020
9AM-12PM 1PM-4PM
BLUE(2020) VOLT (2018/2019)
FEATURINGCOACHESFROM:ARMY,COLUMBIA,MARQUETTE,MOUNTST.MARY'S,OHIO
STATE,STONYBROOK,UMASS,VANDERBILT,WAGNERAND WILLIAM &MARY
VENUEDETAILS:
ST.JOSEPH'SCOLLEGE
246 Service Road
Patchogue,NY 11772
2X NATIONAL
CHAMPION & CURRENT
TEAM USA MEMBER
SESSION: (CIRCLEONE)
$155.00
NAME:
EMAIL:
EMERGENCY CONTACT:
SURGEELITE
LACROSSEACADEMY
EMERGENCY CONTACT PHONE:
LIABILITY RELEASE: IN CONSIDERATION OFMY ATTENDANCE,I,THE
UNDERSIGNED PARTICIPANT INTENDINGTO BELEGALLY BOUND,DO HEREBY
FORMYSELF,MY HEIRS,EXECUTORSAND ADMINISTRATORS,WAIVE,RELEASE
AND FOREVERDISCHARGEANY AND ALL RIGHTSAND DAMAGESWHICH I OR
ANY OFUSMAY HEREAFTERHAVEAGAINST SURGEELITELACROSSEACADEMY
,ST.JOSEPH'SCOLLEGEORITSRESPECTIVEOFFICERS,AGENTS,
REPRESENTATIVES,SUPPLIERS/VENDORSAND/ORASSIGNED FORANY
DAMAGESWHICH MAY BESUSTAINED ORSUFFERED BY MEIN CONNECTION
WITH ORENTRY IN AND/ORARISINGOUT OFMY TRAVEL TO PARTICIPATEAND
RETURN FROM THEFACILITY.
ORSUBMIT TO:
PARENT SIGNATURE:
PAYMENT DETAILS:
BALANCEDUEAPRIL 30TH

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  • 1. LONGISLAND SUMMERSHOWCASECAMP EXPLOREMOREAT SURGEELITELAX.COM MAIL TO: 128 POINTECIRCLESOUTH CORAM,NY 11727 SURGEELITELAX@GMAIL.COM KARA MUPO AND PRESENT JULY 30TH OPEN TOANY AND ALLHIGH SCHOOLGIRLS GRADUATINGIN 2018-2020 9AM-12PM 1PM-4PM BLUE(2020) VOLT (2018/2019) FEATURINGCOACHESFROM:ARMY,COLUMBIA,MARQUETTE,MOUNTST.MARY'S,OHIO STATE,STONYBROOK,UMASS,VANDERBILT,WAGNERAND WILLIAM &MARY VENUEDETAILS: ST.JOSEPH'SCOLLEGE 246 Service Road Patchogue,NY 11772 2X NATIONAL CHAMPION & CURRENT TEAM USA MEMBER SESSION: (CIRCLEONE) $155.00 NAME: EMAIL: EMERGENCY CONTACT: SURGEELITE LACROSSEACADEMY EMERGENCY CONTACT PHONE: LIABILITY RELEASE: IN CONSIDERATION OFMY ATTENDANCE,I,THE UNDERSIGNED PARTICIPANT INTENDINGTO BELEGALLY BOUND,DO HEREBY FORMYSELF,MY HEIRS,EXECUTORSAND ADMINISTRATORS,WAIVE,RELEASE AND FOREVERDISCHARGEANY AND ALL RIGHTSAND DAMAGESWHICH I OR ANY OFUSMAY HEREAFTERHAVEAGAINST SURGEELITELACROSSEACADEMY ,ST.JOSEPH'SCOLLEGEORITSRESPECTIVEOFFICERS,AGENTS, REPRESENTATIVES,SUPPLIERS/VENDORSAND/ORASSIGNED FORANY DAMAGESWHICH MAY BESUSTAINED ORSUFFERED BY MEIN CONNECTION WITH ORENTRY IN AND/ORARISINGOUT OFMY TRAVEL TO PARTICIPATEAND RETURN FROM THEFACILITY. ORSUBMIT TO: PARENT SIGNATURE: PAYMENT DETAILS: BALANCEDUEAPRIL 30TH