Wrestling Team Camp 3 Registration - pay by credit card

July 20-23, 2014

Registration deadline: July 4, 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