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Wrestling Team Camp 2 Registration - pay by credit card

July 14-17, 2014

 Registration deadline: June 28, 2014

Please make a copy of your completed registration form and give it to your coach or team representative, along with a copy of your email confirmation of payment.

* = required field

NOTE: Campers MUST have proof of health insurance (copy of insurance card) provided to Luther college before check-in in order to participate in our camps.
First Name:*
Last Name:*
Address:*
City:*
State:*
Zip code:*
Home phone:
Camper's cell phone:
Camper's e-mail:
Parent's Name(s):*
Parent's cell phone:
Parent's e-mail:*
Grade next fall:*
School:*
Coach's name:*
Birth date:* / /
Age:*
Height:*
Weight:*
State Tournament Honors:
2013-2014 Season Record:
Roommate preference (one name only):
T-shirt Size:*
Refund Policy: Written or e-mailed cancellation notice that is received five or more business days prior to the first day of camp will result in a full refund, less a $50 cancellation fee.
Attending:*
Attending as:*
Payment Amount:*
Payment Method
Credit Card Type:*
Credit Card Number:*
Expiration Month:*
Expiration Year:*
Name as it appears on card:*
Billing Street Address:*
Billing City:*
Billing State/Province:*
Billing Zip/Postal Code:*
Billing Country: