2014 Georgia 11-12, 13-14, Disabled Zone Team Application

The Southern Zone Champs will be held July 29-Aug 3 in San Antonio, TX.  The Georgia Team will leave Monday, July 28 and return Sunday August 3.  The cost for selected participants will be approximately $400.  Financial assistance can be made available in some cases. In order to be considered you must fill out the form below and send in a $100 deposit.  Once you have successfully submitted the form you will receive a confirmation that includes the address to send your deposit.   Your deposit must be received before Monday July 15th. Financial assistance can be made available in some cases.

Applicant's Last Name First Name

Birth date      GenderMale Female

USAS Number   Club

Age Group as of July 29, 2014 

Parent or contact name

Address

City   Zip

Phone Emergency phone

Contact Email

Suit Size   T-Shirt Size

Please read the zone selection policy below and then confirm you have read it using the button below.

I have read and agree to the selection policy. 

Parent would like to be considered for chaperone.