CCofSE Membership Registration 2010-2011

2011-2012 Family Membership Registration


Family Information:
	Father First Name:	Father Last Name:

	Mother First Name:	Mother Last Name:

	Family Mailing Address:

	City:	State:	Zip Code:

	Home Phone Number:	Mobile Phone Number:	e-Mail Address:
	--	--

Please provide the following information on the students in your family whom you expect to participate in this speech and debate season.
Student 1:
	First Name:	Last Name:	Gender:
			Female Male
		Birthday: Month: Day: Year:
Student 2:
	First Name:	Last Name:	Gender:
			Female Male
		Birthday: Month: Day: Year:
Student 3:
	First Name:	Last Name:	Gender:
			Female Male
		Birthday: Month: Day: Year:
Student 4:
	First Name:	Last Name:	Gender:
			Female Male
		Birthday: Month: Day: Year:
Student 5:
	First Name:	Last Name:	Gender:
			Female Male
		Birthday: Month: Day: Year:

Emergency Information:
		Emergency Contact Name:	Emergency Contact Mobile Phone Number:
			--

Club and Coach Information:
		Club Name or Location:	Other Club Information:

		Coach's Name:	Coach's e-Mail Address:


Membership Fee Schedule:
		NOTE: Only PAID CCofSE members may participate in CCofSE Tournaments
	Fee Postmarked BEFORE January 1, 2012		$20.00
	Fee Postmarked AFTER January 1, 2012		$25.00
	Fee Paid at ANY Tournament Check-In		$30.00

By selecting the "Submit" button below, I hereby agree to the CCofSE Code of Conduct and commit to abide by all CCofSE rules and policies, follow tournament regulations as specified onsite, and resolve disputes in accordance with Biblical principles. (Reference: A Commitment to Biblical Conflict Resolution)

NOTE: Selecting the "Submit" button will take you to a Registration Confirmation Page to allow you to confirm all of the data input and provide instructions for submitting your membership fee. (REMINDER: Fees are based on postmark dates, not on-line registration dates.)

20110823