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Brewers Fantasy Camp

Registration Form
Please note, all fields 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 and (Optional, if checked, 'Mobile Phone' must be provided). Msg&Data Rates may Apply. Reply "Stop" to cancel. Text "Help" or email for assistance. Expect 1-2 messages per week.
* Birth Date
* E-mail Address
  I would like to receive commercial e-mails from and

 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. (1,000 character limit)

 Payment Information
* Name on Card * Card Number
* Security Code What is this?
* Expiration Date
* 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 $142.50 credit card service fee per order.
By submitting I acknowledge that I have read, understand and agree to be bound by
the Website Terms of Use and Privacy Policy.