SurvivalGame Account Request Form

All fields are mandatory. Your email address will be used as your login, please make sure it is correct.
You are asked to type your email address and password twice for verification.
Password must be between 5 and 16 characters.

Your credit card will be billed as follows for full season leagues:

Single Entry $50
each additional entry $45.

Name:
Address:
City / St / Zip:
Phone:
Email:
Retype Email:
Password:
Retype Password:
Visa:	Master Card:
AMEX:	Discover:
Credit Card:
Expiration:
Number of Teams:
How did you hear about the SurvivalGame
Returning Player
Member of Boxscore Baseball
Internet Search Engine
Sports Weekly
Fantasy Football Index
Fantasy GURU
A friend told me
Other
If other, how?

YOU MUST CHECK THIS BOX... By checking this box you agree to receive a username and password via email which will enable you to check the results and submit your picks weekly via this website. If you wish to receive the results via US Mail then you must register via phone and you will not have access to the results or picks via this website.