Florida Half Century ASA, Inc.

REGISTRATION FORM 2OO6

TEAM NAME ________________________________________________________

CLASSIFICATION: 50 55 60 65 70

(CIRCLE ONE)

TEAM CONTACT PERSON ______________________________________________

ADDRESS ____________________________________________________________

CITY, STATE, ZIP _____________________________________________________

PHONE _________________________ CELL ______________________________

E-MAIL ADDRESS ______________________________________________________

FIELD MANAGER ______________________________________________________

ADDRESS ____________________________________________________________

CITY, STATE, ZIP _____________________________________________________

PHONE _________________________ CELL ______________________________

E-MAIL ADDRESS _____________________________________________________

Registration Fee is $125 made payable to: FLORIDA HALF CENTURY ASA, INC.

Mail to:

RUDY STRAUSS

8502 NW 21st Court

Sunrise, FL 33322