Wright State Raider AthleticsWright State Raider Athletics

 
Junior Raider Registration Form
Participant Information
First Name:
Middle Name:
Last Name:
Gender

Male
Female
Birthdate:
Age:
T-Shirts:
Parent Information
First Name:
Last Name:
Address:
City:
State/Province:
US or Canada only
Zip:
Home Phone:
Work Phone:
E-mail Address:
How Did You Hear About the Program?
(Check all that apply)		 Newspaper - Please Specify Below

Radio - Please Specify Below

Direct Mail
Friend
1996-06 Junior Raider
Other - Please Specify Below
   

 
 
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