Team/Club Information Club Name * Team Name Team Location Club/Team Twitter Handle Level —AB Team’s Grade —4th5th6th7th8th9th10th11th Coach’s Information Coach’s Name Coach’s Email Coach’s Phone Coach’s Mailing Address Travel Information & Special Requests Check all that apply: Staying Friday Night Staying Saturday Night Commuting Special Requests: Please enter the text in the graphic below: Payment Information Payment Information: Cost is $375 per team and must be paid prior to a team being scheduled for tournament games. $350 per team if registering ≥3 teams You may complete payment via Paypal (3% convenience fee added) after submitting the form, or make check payable to Mid-Penn Motion and mail to: MPM P.O. Box 622 Camp Hill, PA 17011.