|
Full Name (please print) |
Birthdate (M/D/Y) |
E-mail Address |
|
| Skip |
_____________________________ |
_____________________________ |
_____________________________ |
|
| Third |
_____________________________ |
_____________________________ |
_____________________________ |
|
| Second |
_____________________________ |
_____________________________ |
_____________________________ |
|
| Lead |
_____________________________ |
_____________________________ |
_____________________________ |
|
| Coach |
_____________________________ |
Home Club ______________________________________________________ |
|
| Contact |
_________________________________________________________________________________________________
name & mailing address
|
|
| phone - day |
_____________________________ |
phone - evening __________________________________________________ |
|
| Competitive |
circle one |
Recreational |
Entree Fee: $320.00 |
|
| Entree fee must be paid in full before confirmation - no post dated cheques |
