NAME: ___________________________ DATE OF BIRTH: ________

USA CARD #______________________ e-mail address: ____________

Address: ___________________________City: _____________________

Zip Code: __________________________ Phone: __________________

Parents Names: ______________________________________________

2003 Place at USA State Tournament Freestyle:______ Greco:______

Weight Class _______________ (X) one Cadet: ______ Junior: _____

Clothing Sizes: Jacket______T-shirt______Shorts_____Singlet______

Interested in: Freestyle________ Greco________ Both__________

Red Singlet ______________Blue Singlet _________ Both __________

Deposit______________ Check #____________ Balance Due_________