United States of America Deaf Basketball Organization
AL LEPRE, Treasurer
486 WESTBURY AVENUE
CARLE PLACE, NY 11514
E-mail: ALLEPRE@aol.com - Fax: (516) 997-1037 Press 2 after 1st Ring

MEMBERSHIP APPLICATION FOR NEW

U.S.A. DEAF BASKETBALL
ORGANIZATION
(Similar to former AAAD Basketball Organization)

$5.00 - 2008

Print your Name____________________________________________________

Print your Address__________________________________________________

Address__________________________________________________________

E-Mail___________________________________________________________

USADBO Member Number___________________________________________

Check No.________________________________Cash_____________________

Receipt by_________________________________________________________

RECORDING BY AL LEPRE, Treasurer = Dated___________________________

You're in Sports, AL LEPRE, Treasurer Officer