Contact Name: ________________________________________________
Contact Phone: ____- ____-______ Contact Fax: ____- ____- ________
Contact E-mail address: ________________________________________
In the event of an emergency and the competition has to be rescheduled please provide me with an emergency contact number. This number will only be used if the competition has to be rescheduled.
Emergency Contact Number: ____ - _____ - ________
Number of Teams Registered-1
Number of Individuals Registered-1234
Please return this form by competition deadline date.
Confirmation packets will be mailed the first of next year.
Forms can be mailed or faxed to:
Dr. Laquetta K. Cortner