Kickball Sign Up

EmpowHER Experience Kickball Tournament Sign-Up Form

Tournament Date: May 31, 2025 9:00 AM

Location: Broughton Recreation Park, 801 S. MLK Jr Blvd, Longview, TX

Entry Fee: $25/Person | $250/Team or Corporate Sponsor Ages: 17+

Individual/Business (Sponsor) Information

Full Name: ___________________________________________

Business Name: _______________________________________

Address: _____________________________________________

Phone Number: _______________________________________

Email Address: ________________________________________

Team Registration (For Group Sign-Ups)

Team Name: __________________________________________

Team Captain's Name: _________________________________

Captain's Phone Number: _______________________________

Captain's Email Address: _______________________________

Emergency Contact Name: ______________________________

Emergency Contact Phone: ______________________________

Team Members (Up to 10 Players)

1.  

2.  

3.  

4.  

5.  

6.  

7.  

8.  

9.  

10.  

Payment Information

• Entry Fee: $25 per person / $250 per team or Sponsor Vendor Booth: $30

• Payment Method: ☐ Online Payment Link: https://copelandcounseling.us/the-empowher-organization Make Checks Payable To: [The EmpowHER Organization]

Waiver & Agreement: By signing below, I acknowledge that I am voluntarily participating in the EmpowHER Experience Kickball Tournament. I understand that physical activity has inherent risks and I release the event organizers, sponsors, and the venue from any liability. I confirm that I am in good health and agree to abide by the rules of the tournament.

Participant/Business Signature: ____________________________________ Date: ______________

Team Captain Signature (If Team Registration): _______________-__________________________ Submit Completed Forms to: [email protected]

For More Info, Contact: 903.347.3115