CAPITAL CITY UNITED ROCK N ROLL CHAMPS
Official Entry Form 21 July 2007

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Please enter us as competitors in the category CIRCLED below:
JUNIOR CLASS: Social Junior Intermediate Senior Restricted
SENIOR CLASS: Social Masters Golden Platinum Open Senior Restricted Open Restricted
MALE:
FEMALE:

SURNAME:__________________
SURNAME:____________________

FIRST NAME: ________________
FIRST NAME:__________________

ADDRESS:___________________
ADDRESS:____________________

___________________
____________________

PHONE NO: ___________________
PHONE NO: ____________________

D.O.B:___/___/___ AGE: ________
D.O.B. ___/___/___ AGE:_______

CLUB __________________________
CLUB __________________________

We agree to comply with the rules and guidelines of the Capital City Club Champs

Competitors Signatures: ............................................................................................

CLUB SECRETARY’S SIGNATURE:...........................................……...
Entries Close: 10 June 2007

Name: .....................................................………..……………..Club:………….………
Your entry has been accepted to dance in the
Junior/Senior Section
Class .........................................

Name: .....................................................………..……………..Club:………….………
Your entry has been accepted to dance in the
Junior/Senior Section
Class .........................................