2009 Region III Clinic

Region III Clinic    Date - October 3&4, 2009 - Bart Conner Gymnastics
Club Name      Club USAG#:
Team Name(if different):  
Club Address:
City: State: Zip: Region:
Phone: Contact Email:
Name of Coaches Pro # Safety cert. Exp. Date Phone
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Athlete Name USAG # Age as of Sept 1st. 2009-10 Competition Level
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$40 per gymnast or Coach

Mail entry and checks (Made out to Region III) Emerald City Gymnastics, Attn: Region 3 Clinic, 9063 Bond, Overland Park, KS 66214

I hereby acknowledge all rules and regulations handed down by USAGymnastics and the State or Regional Director.  I have read and understand all information pertaining to this meet.  This entry form contains all of the proper names, ages and USAG numbers and classes of my gymnasts.

This for was prepared and filled out by;   (signature)___________________________________________