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Brewers Fantasy Camp 2014

February 2-9, 2014

Registration Form
Please note, all field marked with an asterisk (*) are required.

 Billing Information
* First Name * Last Name
Company Name Contact's Name
* Address Address 2
* City * State
* Zip Code  

 Contact Information
* Day Phone * Evening Phone
Fax Number
Mobile Phone
Enter your mobile phone information to receive text messages & updates from brewers.com and MLB.com (Optional, if checked, 'Mobile Phone' must be provided). Msg&Data Rates may Apply. Reply "Stop" to cancel. Text "Help" or email mlb-mobile-cs@mlb.com for assistance. Expect 1-2 messages per week.
* Birth Date
* E-mail Address
   I would like to receive commercial e-mails from brewers.com and MLB.com.

 Player Information
* Occupation * Age
* Height (ft., in.) * Weight (lbs.)
* Waist (in.) * Uniform (Suit/Dress) Size
* Uniform Number * I need Brewers Home uniform Yes    No
* First Position * Second Position
* Room Smoking Preference Smoking    Non-Smoking
   
* Do you have a medical condition?
Yes    No
If yes, please provide details that might affect your complete participation.


 Payment Information
* Name on Credit Card * Credit Card Number
* Credit Card Expiration
* Credit Card Type
Amount to Charge
The sales tax ultimately charged to your credit card will be calculated when your credit card charge is authorized and will reflect applicable state and local taxes. Your billing confirmation email will include the final amount of sales tax charged.
There is a $20.00 online convenience fee and 3% credit card service fee per order.