2011 / 2012 King of the Groms / King of the AMs - Mail In Registration Form

 

Entry Fee(s):  75.00 per location - includes 1 event +10.00 for each additional event

(2 events = 85.00, 3 events = 95.00, 4 = 105.00)

  1.Name of entrant: _________________________________________

1.5    Nickname:__________________________________________

 

2.Contest location:  (CIRCLE ALL THAT APPLY)

 

Skaters Edge,   3rd Lair,    Progressive,    Skatelab,     Southside,     Kids That Rip

 

3.Entrants Age: ___________

 

4.Entrants Date of Birth: _____________ (10 years old and up may require birth certificate)

5.Entrants Mailing Address - Street: ________________________________

City: ___________________________  State: __________  Zip: _____________

5.5     Email Address: _________________________________

6.T-shirt size:  (CIRCLE ALL THAT APPLY)

Youth -  Small   Med   Large   |OR|   Adult  -  Small   Med   Large   XL

 

7.Sponsors you know of for each entrant:____________________________

___________________________________________________________________

___________________________________________________________________

8.Division(s) / Event(s): (CIRCLE ALL THAT APPLY)

BEGINNER STREET          BEGINNER MINI-RAMP          BEGINNER BOWL

INTERMEDIATE STREET         INTERMEDIATE  MINI-RAMP         INTERMEDIATE  BOWL

EXPERT STREET           EXPERT MINI-RAMP           EXPERT  BOWL

BEGINNER VERT            INTERMEDIATE VERT            EXPERT VERT

KING OF THE AMS DIVISION -      'OPEN'     'AM;

10.    Parents Name(s) and Phone Number(s): ___________________________

___________________________________________________________________

                    

11.    Make check payable to 3rd Lair - in the correct amount: ______________

Mail to: King of the Groms 850 Florida Ave. Golden Valley, Mn. 55426