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Pop Up Bar Registration (1/2 price)
CenterlineAdmin
2025-10-30T04:19:30+00:00
Pop Up Bar Registration
Pop Up Bar Registration- 1/2 Price
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Contact
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First
Last
Date/Time selected
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Friday, Nov. 28th, 5:30-7:30pm
Friday, Nov. 28th, 8:00-10:00pm
Saturday, Nov. 29th, 5:30-7:30pm
Saturday, Nov. 29th, 8:00-10:00pm
Friday, Dec. 5th, 5:30-7:30pm
Friday, Dec. 5th, 8:00-10:00pm
Saturday, Dec. 6th, 5:30-7:30pm
Saturday, Dec. 6th, 8:00-10:00pm
Friday, Dec. 12th, 5:30-7:30pm
Friday, Dec. 12th, 8:00-10:00pm
Saturday, Dec. 13th, 5:30-7:30pm
Saturday, Dec. 13th, 8:00-10:00pm
Friday, Dec. 19th, 5:30-7:30pm
Friday, Dec. 19th, 8:00-10:00pm
Saturday, Dec. 20th, 5:30-7:30pm
Saturday, Dec. 20th, 8:00-10:00pm
Friday, Dec. 26th, 5:30-7:30pm
Friday, Dec. 26th, 8:00-10:00pm
Saturday, Dec. 27th, 5:30-7:30pm
Saturday, Dec. 27th, 8:00-10:00pm
Phone
*
Alt Phone
Email
*
Product Name
Quantity
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Price:
$5.00
Quantity
Total
Additional Comments
Permission and Authorization WAIVER Form
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I, the undersigned, do hereby certify that I shall assume all financial responsibility for any injury to the above named player. I waive, release, absolve, indemnify, and agree to hold harmless Centerline Volleyball, itโs referees, coaches, participants and persons included in all league activities, for any injury, transporting to and from those activities to include participation, from all claims or liability directly or indirectly for any claim arising out of injury to the player or myself. I certify that I have my own insurance.
If I, the undersigned, cannot be reached in the event of an emergency, I also give consent for the league directory, referees or coaches to obtain through a physician or a hospital of its choice, such medical care as is reasonably necessary for the welfare of the player.
I Agree
Credit Card
*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
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02
03
04
05
06
07
08
09
10
11
12
Year
Year
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
Security Code
Cardholder Name
Phone
This field is for validation purposes and should be left unchanged.
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