Friends of Frederick E. Samuel Foundation, Inc.
Clyde Frazier Jr.
SlamJam Women's Basketball
2472 Adam Clayton Powell Jr. Blvd.
New York, New York 10030
(212) 862-4216
(212) 491-3608 fax

Player Registration Form (each player must fill out this form).
Last Name:   First Name:
Address Line 1:   Telephone:
Address Line 2:   Telephone:
Date of Birth:     Race:
Guardian's Name:   Guardian's Signature:
Emergency Contact:   Relationship:
   Telephone:
School Information
Name of School:
Address:   Telephone:

Grade:   Guidance Counselor:
AAU Coach Name:   Telephone:
Interested in College:
Yes:     No: