| Athlete's Name | Emerson Fassbinder |
|---|---|
| Athlete's Birth Date | 10/09/2008 |
| Entry Date | 09/29/2025 |
| Insurance Provider | BCBS |
| Insurance Policy Number | 1234 |
| Primary Contact Name | Joel Fassbinder |
| Primary Contact Email | Email hidden; Javascript is required. |
| Primary Contact Phone | (406) 581-2325 |
| Alt Contact Name | Irene Fassbinder |
| Alt Contact Email | Email hidden; Javascript is required. |
| Alt Contact Phone | (406) 581-4947 |