COMPETITIVE ENTRY FORM
2010 Level 4 State Meet
March 13&14, 2010
Hosted By CCGI
Meet Site: Santa Rosa Rancheria
16085 Jersey Ave.
Lemoore, CA 93245
Section A- CLUB INFORMATION Please complete all fields.
CLUB NAME: _________________________________________________________
Address: ___________________________________ USAG Club #______________
_______________________________________________________________
Telephone: _______________ Fax: ______________ E-Mail: _________________
Contact Person: ___________________ Contact Phone: _______________________
Coach A: _________________ Pro #________ Expiration_______ Safety Exp. ______ Background _______
Coach B: _________________ Pro# ________ Expiration_______ Safety Exp. ______ Background _______
Coach C: _________________ Pro# ________ Expiration_______ Safety Exp._______ Background _______
Section B- Athlete Information Men-Level 4
Name of Gymnast USAG# Level Birthdate Age as of 9/1/09 Sweatshirt or T-Shirt
Size Size
1.________________________ ______ ____ __________ __________ _______ _______
2.________________________ ______ ____ __________ __________ _______ _______
3.________________________ ______ ____ __________ __________ _______ _______
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6.________________________ ______ ____ __________ __________ _________ _______
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8._______________________ ______ ____ __________ __________ ________ ________
9.________________________ ______ ____ __________ __________ ________ ________
10.________________________ ______ ____ __________ __________ ________ ________
11.________________________ ______ ____ __________ __________ ________ ________
12.________________________ ______ ____ __________ __________ ________ ________
Section C – TOTAL BALANCE DUE Registration deadline: February 15, 2010
________ Level 4 Gymnasts x $75 each =$_________
T-Shirt Total $15 x _________ =$_________
Sweatshirt Total $30 x _________ =$_________
Enclosed check number: ________ Total amount Enclosed =$_________
Please make check payable to: CCGI Team Account: 9514 W. Pershing Ave., Visalia, CA 93291
Attention: John Keeter (559)651-2244 E-mail: iloveccgi@earthlink.net, Web Site: iloveccgi.com
No personal checks from parents please!!!!!! Entries are due no later than 2/15/2010