Region V All Purpose Entry Form
Type information into the blocks with your keyboard
| Club Name | |
| Club Address | |
| Club Phone and Fax Number | |
| Club Email |
Coaches Please register - NO COST
| Name | Level |
USAG # |
B-day |
Age |
Comp
|
Opt
|
Camp |
Coach
(C) |
CAMP $175
COMPULSORY $75 OPTIONAL $75 C/O
$100
(Camps include: Compulsories, Physical Abilities and
Camp)
Amount Enclosed $
Refunds will only be given prior to the start of a camp or competition
Please fax this form with a copy of the check made payable to **
Mary Lee Tracy ** Cincinnati Gymnastics
FAX 513-870-3831 or usamlt@aol.com
Phone 513-860-3082
Host Hotel:
Holiday Inn Express
Rt. 4 Fairfield, Ohio 45014
513-860-2900
Call or email if you have any questions. Thank You!