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Flips USA

GYMNASTICS

2003Gold Dust Invitational

 

Team Registration Form & Roster

October 18 & 19 2003

 

*Club:________________________________     *Phone: (     )___________*Fax:(    )____________

 

Club Short Name:_____________________ *E-mail__________

 

*Club Address:_______________________     *City:______________ *State:_______ *Zip:__________

 

*Gym Club Number:_____________ Contact person:________________ Contact Phone:____________

 

*Coach A: ________________________*Safety Exp. Date: ____________*USAG# ___________*Exp_____

 

*Coach B: ________________________*Safety Exp. Date: ____________*USAG# ___________*Exp_____

 

*Coach C: ________________________*Safety Exp. Date: ____________*USAG# ___________*Exp_____

 

*Coach D: ________________________*Safety Exp. Date: ____________*USAG# ___________*Exp_____

 

* These fields must be completed

 

 (No Team Fees!) We will use the top 3 scores for the team total

Please type or print legibly.

 

              Gymnast                                Level                  USAG#                      Date         

        First/Last Name                                                                                       of birth       

 

      ____________________           __________         ______________        __________

 

      ____________________           __________         ______________        __________

 

      ____________________           __________         ______________        __________

 

      ____________________           __________         ______________        __________

 

      ____________________           __________         ______________        __________

 

      ____________________           __________         ______________        __________

 

      ____________________           __________         ______________        __________

 

      ____________________           __________         ______________        __________

 

 

                        __________________Gymnasts @ $65.00 per gymnasts     Total: ________

 

Note: Make Checks payable to Flips Gymnastics Corporation (Flips Corp.). Fee entry deadline is Sept. 1, 2003.

 

 NO REFUNDS after September 1, 2003  Duplicate this form if necessary.