Player/Team Name____________________________
Age Division______________________ (include age group and sex)
E-Mail____________________________________
Phone (__)____-_________ Fax (__)____-_________
Mobile (__)____-_________
Address_____________________________________
City_________________ State______________ Zip________
Mailing Address (if different than
above)________________________________________

Applicant Signature _____________________________________ Date__________
It is important to complete the application in its entirety. Please type or print
legibly. To be eligible, all monies and registration forms must be received
prior to trip.

The cost per person:
New Zealand = See Flyer for details: http://www.floridassa.com/newzealand.pdf
Maui = $1,595.00 per person

Checks should be made payable to
Florida Senior Sports Association, and sent to:
Florida Senior Sports Association
c/o Ed Rose
5400 Sandlake Dr.
Melbourne, FL 32934
Package Price includes RT airfare from Orlando to Maui and Accomodations.
Package Price is based on two persons per room.

For more detals please contact:
Ed Rose e-mail: edrose@cfl.rr.com
Tel: (321) 254-1495
Website: http://www.floridassa.com