KANSAS MEN’S
STATE GYMNASTICS CHAMPIONSHIPS
Hosted By: Air Capital Gymnastics
2909 S. Spruce – Wichita, KS –
67216
316-691-3345
acg@cox.net
USAG Sanctioned Entry Form
Club Name_______________________________________Contact________________________
Address________________________________________________________________________
Phone_____________________________________E-Mail_______________________________
Head
Coach___________________________USAG#__________Safety Expiration__________
Asst Coach____________________________USAG#__________Safety
Expiration__________
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Competitors Name |
USAG# |
Level |
Birth Date |
Age as of Sept.1 |
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# of USAG Sanction Level 4-10_______________X
$60.00 = $________________
Circle Teams Entered: 4 5 6 7 8 9 10
# Teams_________X $35.00 =
$___________
Total Amount Enclosed =$ _______________ *Checks payable to Air Capital Gymnastics*