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East Race Nationals Training Camp

From: Mruss97@aol.com
Date: Mon, 20 Jul 1998 17:38:27 EDT
Subject: East Race Nationals Training Camp

East Race National Training Camp

August 3rd thru August 6th 1998



Name_______________________________ Birthdate_____________________

Address___________________________________________________________

City_______________________State__________________Zip______________

Phone ______________________________ K-1__ K-1W__ C-1__ C-2__

USCKT#____________________________Must be a memeber of USCKT to participate

All participants must have a combat (whitewater) roll. All participants under the age of 16 must have a parent/guardian accompany them as there is NO supervision outside of the training sessions.

Cost is $20/day for coaching. Food & Lodging are on your own.

I will need coaching Aug 3rd___ 4th___ 5th___ 6th___

# of days coaching needed ____________ X $20/day =______________

Please return the registration as soon as possible as I will only be accepting 15 participants since Scott Straughsbaugh & Wayne Dickert will also be having training camps at the same time. I will also provide open water time for those not wishing to participate in a camp. Please send your registration from with a check made out to East Race Club , to Marilyn Russell, 6190 Sunny Vale, Columbus, Ohio 43228- must be mailed by July 27, 1998.

Coaches will be Rebecca Bennet, Josh Russell & Wayne Russell

If you have any questions please call Marilyn Russell 614-870-7485 after 5:15pm weekdays, or all day saturday and sunday.

PLEASE CALL BEFORE SENDING IN REGISTRATION AS THE CAMP IS FILLING UP.

Special Concerns. Please list any health problems which the coaches should be aware of. This information will be kept confidential. The purpose is to assist us in case of emergencies to give us as much information as possible. It would also be appropraite to list any special concerns that you may have about your son or daughters participation.

In case of an emergency I authorize ______________________________________ or camp personnel to seek medical assistance for my child. Should such medical assistance be provided I will be responsible for payment of medical treatment.

Below is information regarding my insurance:

Insurance Policy #_______________________________________

Insurance Company________________________________________

Policy holders name_________________________________________

Home phone #___________________________Work PHone #_________________

Parent/Guardian Signature if under 18_____________________________________


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