Please make checks out to NYLAX, LLC and mailed to NYLA by April 15th, 2022:

NYLAX, LLC
P.O. Box 388
Williston Park, NY 11596

Payment is $1,699.00 per team. For any questions, please contact us at: info@nylaxacademy.com

Team Name

Bracket

Please select the most appropriate bracket for your team.

Additional Team Names and Brackets

If you are registering multiple teams, please list the team names and the most appropriate bracket for each additional team.

Contact Person

First Name

Last Name

Contact Email

Coach Name

First Name

Last Name

Coach Email

Coach Cell Phone

(###)

###

####

Additional Coach Contact Information

If you are registering multiple teams, please provide the coach first and last name along with email address for each additional team.

Team Website/URL

http://

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

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