PLEASANT VALLEY

MEN’S ALUMNI
BASKETBALL GAME

Saturday, Jan. 2nd @ 10:00 AM

Pleasant Valley High School Gym

Game(s) format will be determined

by number of players entered.
$20 Fee for T-shirt and officials.
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Send registration and $20 to Pleasant Valley High School % Steve
Hillman, 604 Belmont Road, Bettendorf, IA 52722 *Registration
may be turned in the day of the game.

Name: _____________________ Year Graduated:___________

ADDRESS____________________________________________________________________

HOME PHONE #_____________________WORK/CELL PHONE#___________________

E-MAIL ADDRESS _____________________________________

I release the Pleasant Valley School District for accidents that may occur at this game.

Signed:_______________________________________________ Date: _____________________