<p> 2014 USSSA Wisconsin Baseball State Tournament Entry Form</p><p>Team Name USSSA Sanction # (Starts with 814 or 914)*</p><p>Manager Name Email</p><p>Cell Phone Alternative Phone</p><p>Address City State Zip</p><p>*(If not USSSA member please enclose annual fee of $40 and we will sanction team upon registration) USSSA Class (Please circle one): Major AAA AA A</p><p>2014 State Tournament Attending (must check one) June 20-22, 2014 – deadline to register: June 6</p><p>□ 8 & Under Kid Pitch – Oconomowoc ($325 + $100GF) □ 9 & Under State Open – Woodside: WI Dells ($375) □ 10 & Under AA – Oconomowoc ($375+ $100GF) □ 10 & Under Open – Oconomowoc ($375+ $100GF) □ 11 & Under AA – Woodside: WI Dells ($395) □ 11 & Under Open – Woodside: WI Dells ($395) □ 12 & Under AA – Appleton ($395+ $100GF) □ 12 & Under Open – Appleton ($395+ $100GF) □ 13 & Under AA – Woodside: WI Dells ($450) □ 13 & Under Open – Woodside: WI Dells ($450) The 2014 State Championships MAY Have either a Pre-Paid Gate Fee of $100 or an on-site Gate Fee depending on the Facility.</p><p>June 27 -29, 2014– deadline to register: June 13 □ 14 & Under A/AA – Madison ($450+ $100GF) □ 14 & AAA/Maj – Madison ($450+ $100GF) □ 15 & Under – Kenosha ($500+ $100GF) The 2014 State Championships MAY Have either a Pre-Paid Gate Fee of $100 or an on-site Gate Fee depending on the Facility. ______Credit Cards Accepted (Circle One) MC / Visa / Amex / Disc Payment Information: </p><p>Tournament Fee $______Name on Card</p><p>Pre-Paid Gate Fee $__100*_____ (*Woodside Sports will have on On-Site GF. $100 Pre-Paid not required for 9u, 11u, 13u) House Number and Zip Code - Linked to CC </p><p>USSSA Sanction Fee $______Phone Number of CC Holder Total Amount Enclosed $______(Make checks payable to Premier Sports for credit card info see right)</p><p>Mail Form to: Credit Card # Premier Sports and Events Management ______9960 W. 191st St, Suite A Exp. Date Security Code Mokena, IL 60448 708.675.1500 P. 708.675.1505 F. Signature of Authorized User [For Office Disc:______Rcvd on: ______Entrd by: ______C#:______Use Only]</p>