2006 IC Xtreme Team Registration
Form
Challenge_______________________
Division_________
TEAM NAME
______________________________
Membership/Organization
Name:_____________________________________
Membership
Address_____________________________________________________
TEAM Contact
Person:__________________________ Phone __________________________
Email
(print carefully)____________________________________
TEAM Contact
Address_____________________________________________________
Home Email 1
(print carefully)_____________________________________________
2nd Team
Contact (if appropriate) ________________________________
Phone_____________________
Home
Address2_____________________________________________________
Home Email 2
(print carefully)_____________________________________________
| Team Member Name |
Grade |
Phone |
# of years in DI
|
| _________________ |
______ |
______ |
______ |
| _________________ |
______ |
______ |
______ |
| _________________ |
______ |
______ |
______ |
| _________________ |
______ |
______ |
______ |
| _________________ |
______ |
______ |
______ |
| _________________ |
______ |
______ |
______ |
| _________________ |
______ |
______ |
______ |
Send registration AND $50 team registration fee to:
Peggy
Middendorf, 3817 Raymonde Lane, Erlanger, KY 41018
The $50 tournament
fee MUST accompany the registration form to hold your place at IC Xtreme
QUESTIONS??????????
Call Peggy Middendorf at 859-727-2733 or email
Peggy at middendorf@zoomtown.com