Coach's Name *

First Name

Last Name

Coach's Phone *

(###)

###

####

Billing Contact Phone *

(###)

###

####

Billing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Paying for Evaluator

$40 Fess per 6 Teams/Individual

Yes ( Skip to Payment Option)

No

Trained Evaluator1

1 for each 6 Teams/Individual.

First Name

Last Name

Trained Evaluator 2

1 for each 6 Teams/Individual

First Name

Last Name

Payment Option *

Registration Fees per team/individual: Team : $130 Individual :$30

Check(Prior to April 5th)

Paypal (Additional 5% processing fees)

Purchase Order