Region V All Purpose Entry Form
 Competitions and Training Camps

Club Name

Club Address

Club Phone and Fax Number

Club Email

        Coaches Please register - NO COST

Name

Level

USAG #

B-day

Age

Comp
(X)

 

Opt
(X)

 

Camp
(X)

Coach (C)
Athlete (A)
Judge (J)

         Please fax this form with a copy of the check made payable to:

         Cincinnati Gymnastics 
Fax # 513-870-3831 or usamlt@aol.com
Phone - (513) 860-3082

CAMP $200      COMPULSORY TEST $75     OPTIONAL TEST  $75    C/O TEST $100
(Camps include: Compulsories, Physical Abilities and Camp)
Amount Enclosed: _____________

*Refunds will only be given prior to the start of a camp or competition

Host Hotel: 
Holiday Inn Express 
Rt. 4 Fairfield, Ohio 45014
513-860-2900

Call or E-Mail if you have any questions. Thank You!