Sign-up Information Form

In order to prevent false Sign-ups, this form will be sent using your default e-mail. If there is not a default e-mail set up on your computer. This page will error out after you submit the form. If this happens Please call Leon at 209-204-4243 or send an e-mail to leonb@modestoraiders.com

Modesto Raiders
Sign-up Information Form

General Information

Name:	First	Last
Address:
City:		State
Phone:	Home	Work
Age:
Height:
Weight:
Primary Position:
Secondary Position:
Highest Level Played:
High School Attended:
Football Nickname:
College Attended:
Email Address:

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