CAPITAL CITY UNITED ROCK N ROLL CHAMPS
Official Entry Form 21 July 2007
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Senior Pro-Am
Please enter us a competitors in the above class:
Male:
SURNAME:__________________ FIRST NAME: ________________
ADDRESS:___________________________________________________________
PHONE NO: ___________________ D.O.B:___/___/___ AGE: ________
CLUB __________________________
Female:
SURNAME:__________________ FIRST NAME: ________________
ADDRESS:___________________________________________________________
PHONE NO: ___________________ D.O.B:___/___/___ AGE: ________
CLUB __________________________
We agree to comply with the rules and guidelines of the Capital City Club Champs
Competitors Signatures: ............................................................................................
CLUB SECRETARYS SIGNATURE:...........................................
...
Entries Close: 10 June 2007
Name: .....................................................
..
..Club:
.
Your entry has been accepted to dance in the
Senior Pro-Am Section
Class .........................................
Name: .....................................................
..
..Club:
.
Your entry has been accepted to dance in the
Senior Pro-Am Section
Class .........................................