December 5-6, 2009
	Team Name:			USAG CLUB #
	Contact Name:			Email:
	Coach's Name:			USAG  #
	Coach's Name:			USAG  #
	GYMNAST NAME	USAG Member #	LEVEL                               If PO, list Gold/Silver	BIRTHDAY    00/00/00	AGE                          *As of State Meet	Shirt Size
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	Level 2 totals           X $55 =	Level 7 totals             X $75 =
	Level 3 totals           X $55 =	Level 8 totals             X $75 =
	Level 4 totals           X $65 =	Level 9 totals             X $75 =
	Level 5 totals           X $65 =	Level 10 totals           X $75 =
	Level 6 totals           X $65 =	Prep-Op totals           X $75 =
	SUBTOTAL:                                        +	Team Fees                X $35 =
	TOTAL BALANCE: