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PHILADELPHIA DIVISION – U.S.F.A (http://www.phildiv-usfa.org)

2006-2007 JUNIOR OLYMPIC QUALIFIERS ENTRY FORM

Last Name____________________________ First Name_______________________

Birth Date____/____/____ Club_____________ USFA #________________________

Phone #_____________________E-Mail____________________________________

(A current USFA membership cards must be presented at check-in for each event or

a USFA registration form will need to be completed and membership paid for at the door)

Fee calculation example:
1 event first day, 2 events the second day: (3 events x $25) + $15 fee = $90 total
Late registration penalty: All registration and event fees are double (above example, $180)
Entries received but not paid by closing dates will be considered late. and late fees will apply

• Late registrations by mail will be accepted after closing dates (above) and at the door
• Event fees only will be refunded if notification is received at least 7 days in advance of event; refunds will be made only after completion of tournament

You may register online at www.askfred.net or mail your completed form and payment to:

Karen Howard, Secretary
Philadelphia Division-USFA
18 West Mount Airy Avenue
Philadelphia PA  19119

Be sure to allow sufficient mail delivery time and to send payment with your form to avoid late fees