ROSTER/STATEMENT OF INTENT FORM FOR

SPONSOR BAR NAME BUDDY'S INN LOUNGE

dart team name PARTY AFTER FIVE

ADDRESS 2724 25TH AVE

LINDA WOODALL CAPTAINS NAME

CO-CAPTAINS NAME

sponsor signature TERRY "MOUSE" RAMEY

SPONSORED BY

CITY, STATE ZIPMS 39501 GULFPORT

ADDRESS 18116 ROBIN OAKS DR

CITY, STATE ZIPMS 39503 GULFPORT

ADDRESS

CITY, STATE ZIP

Sponsor NUMBER 228-868-0073

CELL PHONE 228-265-1539 CELL PHONE

name team name FIVE LOUNGE I, the undersigned, agree to play darts with the PARTY AFTER dart team, sponsored by BUDDY'S INN sponsor for the upcoming W/S S/F 2015 YEAR. I understand that I may not sign with another team unless I am first released by this team. also understand that should I sign with another team without obtaining this release, I will be suspended for an indefinite period and that

any points scored by me and/or my partner will be subject to forfeiture. When I am released, the team captain will draw a line through my name and complete the release information block. I will then initial after the captains name for acknowledgement.

The top portion of this roster is to be completed BEFORE any player signs below

DO NOT WRITE IN CARD NUMBERS WHEN FILLING OUT FOR W/S

CARD #

PLAYER NAME (printed)

PLAYER SIGNATURE

DATE SIGNED

LINDA WOODALL

228-265-1539

11/14/14

EDDIE WOODALL SEAN MARTEL

228-596-3538

"

228-806-1792

"

RON MARTEL

228-236-4677

"

ROBERT ATCHLEY DANNY LADNER

228-216-3368 228-223-2035

" "

TABITHA WALLER

228-239-4932

"

LAST TEAM

Players Phone #

DATE RELEASED

INITIALS

PGSCB P"G S C B P"G S C B P"G S C B P"G S C B P"G S C B PNONE GSCB PGSCB PGSCB PGSCB PGSCB PGSCB

PARTY AFTER 5

This form is to be filled out and (e)mailed or submitted on the M.G.C.D.A. website. W/S season by 6pm December 1

S/F season by 6pm June 1

MGCDA, P.O. Box 7391, D'Iberville, MS 39540

REVISED 2013