| BATTLE OF CHAMPIONS - ENTRY FORM | |||||||||||
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| Team Name: | |||||||||||
| Gym Address: | City: | State: | Zip: | ||||||||
| Gym Phone #: | Gym Fax: | E-mail: | |||||||||
| Coaches Name: | Coaches USAG #: | USAG Exp. Date: | |||||||||
| Coaches Name: | Coaches USAG #: | USAG Exp. Date: | |||||||||
| Coaches Name: | Coaches USAG #: | USAG Exp. Date: | |||||||||
| # of Gymnasts Entered: | @ | $95.00 = | $ | ||||||||
| # of Teams Entered: | @ | $60.00 = | $ | ||||||||
| Total Amount Enclosed: | $ | ||||||||||
| Name | USAG # | Birthdate | Age | Level | |||||||