Registration for ALM JUNIOR OLYMPIC and SUMMER NATIONALS U19 TEAM QUALIFIER

Participants must be a member of the USFA (membership available at event**).   All USFA rules apply.

Participants (parent/guardian of minor) must sign a Waiver of Liability; forms will be available at the venue.

Fencers under the age of 18 MUST have parent or guardian signature on forms to participate.

Want to view who is registered?

** Under 18 fencers must have parents signatures on USFA membership aps, and no cash please.

Please provide the following contact information:

Name
Club
USFA Membership #
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Home Phone
E-mail
Date of Birth	MMDD19YY
Classification	Example "E02" F E S
Events Entering	U17MF   U17 ME    U17MS
Events Entering	U17WF   U17 WE    U17WS
Events Entering	U20MF   U20 ME    U20MS
Events Entering	U20WF   U20 WE    U20WS
Events Entering**	U19 TMF   U19 TME    U19 TMS
Events Entering**	U19 TWF   U19 TWE    U19 TWS
Registration and one individual event                     $22.50   ** Team Event is one fee of $30 per club entry   Additional Fees Add $10 for each additional event   $    Total due on arrival at venue                              $   By submitting this form you are agreeing to submit payment if you fail to notify the secretary of the division before the event that you will be unable to attend. Make Checks Payable to: Ark-La-Miss Division Questions???? email Terry Harkey or call 1-318-458-3779 Last revised: February 12, 2004