GYMNASTICS
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.
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__________________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.