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| State Meet Entry Form |
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Level 4,5,6 State Championship - ENTRY FORM |
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April 11, 12, & 13, 2008 |
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Please mail Entry Form to: |
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Pam Halker - Halker's Gold
Gymnastics |
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310 Birch |
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Columbus Grove, OH 45830 |
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Entry Deadline is March 15, 2008 |
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Team Name: |
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Gym Address: |
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City: |
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State: |
Zip: |
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Gym Phone #: |
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Gym Fax: |
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E-mail: |
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COACHES EMAIL: |
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Coaches Name: |
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Coaches USAG #: |
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USAG Exp. Date: |
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Coaches Name: |
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Coaches USAG #: |
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USAG Exp. Date: |
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Coaches Name: |
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Coaches USAG #: |
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USAG Exp. Date: |
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# of Gymnasts Entered: |
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$60.00 = |
$ |
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# of Teams Entered: |
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$50.00 = |
$ |
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Total Amount Enclosed: |
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$ |
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Name |
USAG # |
Birthdate |
Age |
Level |
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US Citizen |
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