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La Broquerie Minor Baseball / Softball Account Creation
Parent / Guardian Account Information
Parent 1 First Name :
*
Parent 1 Last Name :
*
Parent 2 First Name :
Parent 2 Last Name :
Email :
*
Address :
*
Town :
*
Province :
*
Postal Code :
*
Phone (primary) :
*
Phone (secondary) :
Username :
*
Password :
*
Password (again) :
*
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