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Missouri State
Championships
March 30, 31 and
April 1, 2007 |
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TEAM NAME:
_______________________________________ PHONE:
_________________________ |
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TEAM
ADDRESS:______________________________________________________________________ |
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CITY: __________________________________________________ STATE:
_____ ZIP: _________ |
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E-MAIL ADDRESS: ______________________________________ CLUB #:
____________________ |
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COACH(S) NAME: ________________________ |
COACH(S) NAME: ________________________ |
_______________ |
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USAG #: ____________ |
USAG #: ____________ |
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Safety Cert. Expiration Date: ________________ |
Safety Cert. Expiration Date: ________________ |
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NAME |
LEVEL |
D.O.B. |
U.S.A.G.# |
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Entry Fee: |
_____ Team entries@ $30.00 = _________ |
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____ Level 5 gymnasts @ $65.00 = ________ |
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Level 5 ____ Level 8 ____ |
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____ Level 6 gymnasts @ $65.00 = ________ |
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Level 6 ____ Level 9 ____ |
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____ Level 7 gymnasts @ $65.00 = ________ |
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Level 7 ____ Level 10 ____ |
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____ Level 8 gymnasts @ $65.00 = ________ |
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____ Level 9 gymnasts @ $65.00 = ________ |
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Total Due - __________ |
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____ Level 10 gymnasts @ $65.00 = ________ |
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