Form 3B

FORM 3B

Florida Half Century ASA, Inc.

Permanent Roster Addition

DATE ___________________________________

I _____________________________________ FHCASA ______________________

Print Name

Hereby transfer from _________________________________ Division _________

Old Team (if not on a roster state none)

To:_____________________________________________ Division ____________

New Team

Player Must Complete The Following Information

NAME________________________________________________

Address_______________________________________________

City, State, Zip__________________________________________

Phone_________________________________________________

In making this roster change, I understand that I will not be eligible to return to the team I resigned from for a minimum of 6 months from the date of my resignation. This includes as a 3A pickup player.

_______________________________

PLAYER'S SIGNATURE

*********************************************************************************************************************

Player’s Manager must sign off on form to verify all information is correct.

___________________________________________

MANAGER

MAIL COMPLETED FORM TO:

Rudy Strauss 8502 NW 21st Court

Sunrise, FL 33322

FAX (954) 748-8490

FORM 3B - Revised 8-20-05, (RS)