regform



		Indiana YHEC Registration Form

	Please Print Clearly

Last Name:_________________________________________________________________________ First Name:_______________________________________________________ M.I.:___________ Address:___________________________________________________________________________ City:______________________________________________________________________________ State:_________________ ZIP:_______________ Phone:________________________________ E-mail:_____________________________________________________________________________ Gender: Male _______ Female _______ Birthdate: Month _______ Day _______ Year _______ Division: (Based on age on September 12, 2009) Jr. _______ (ages 11 to 14) Sr. _______ (ages 15 to 19) Coach or Sponsor (optional):__________________________________________________________ Team Name (optional):_______________________________________________________________ Parent/Guardian:____________________________________________________________________ Parent/Guardian Signature:___________________________________________________________

			Please return this form and $15 entry fee, along with a copies of birth certificate and Hunter Education certification, not later than Aug. 12, 2009 to:

				InYHEC 6229 S. 1100 E. Otterbein, IN 47970

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