Wrestling Team Camp 3 Registration - pay by credit card

July 19-22, 2015

Registration deadline: July 8, 2015

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 (MM/DD/YYYY)*
Age*
Height*
Weight*
State Tournament Honors
2014-2015 Season Record
Roommate preference (one name only)
T-shirt Size*
Refund Policy: Written or e-mailed cancellation notice that is received ten 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

Name as it appears on card*
Credit Card Number*
Credit Card Type*
Expiration mm/yyyy*
Security Code*