Men's Levels 4 - 10
Women’s Levels 3 - 10 & Prep-Op
January 15th -
17th
Felicia Boudreau, Meet Coordinator e-mail: felicia@vssg.lvcoxmail.com
Website: www.vssg.net Phone: (702) 259-5020 Fax: (702) 645-9173
Registration Deadline:
December 1st
Team
Name: ______________________________ USAG Club #: ___________________
Address:
________________________________________________________________
City:
Fax#:
_____________________ E Mail Address: ________________________________
Coach’s
Name: _______________________ Coach’s Name: ______________________
USAG
Pro Member #: __________________ USAG
Pro Member #: _________________
Pro
Member Exp. Date: _________________ Pro
Member Exp. Date: _______________
Safety Certification Exp. Date: ___________ Safety Certification Exp. Date: __________
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FIRST NAME
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LAST NAME
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USAG #
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LEVEL |
BIRTHDATE |
US CITIZEN? |
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exp. |
Sally |
Smith |
123456 |
4 |
01/11/2000 |
Y N |
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All fees must Mens' Entries (Levels 4 - 10) ____ x $80 = ______
accompany entry form. Womens' Entries (Levels 4 - 10) ____
x $80 = ______
Womens' Prep-Op & Level 3 Entires ____ x $60 = ______
USAG Foreign Registration Fee ____ x $25 = ______
Teams Womens' 4 5 6 7 8 9 10
Mens' 4 5 6 7 8 9 10 ____ x $50 (per team) = ______
(Circle all that apply)
Top 3 scores count
for team score with one team per level.
Total Entry Fee =
_____
Make single club check payable to: V.S.S.G.