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REGISTRATION FORM Pg.11
Matrix Registration Form
(All Members must have a Current USA Card Year 2001-2002)    LETTERING IS MADE DARK FOR PRINTING PURPOSES
Pick the site location and the Sessions you would like to join, add up the costs, then mail the registration form to the address below.
Club Site
Cost
Cost of USA CARD
Bethlehem Catholic - Session 1.............................
   $160.00
          $30.00
Bethlehem Catholic - Session 2.............................
   $100.00
Great Valley - Session 1.........................................
   $160.00
Great Valley - Session 2.........................................
   $140.00
Avon Grove Session...............................................
   $160.00
Schukyll Valley Session I........................................
   $100.00
Schukyll Valley Session II.............................            $100.00                        
Discount for teams often wrestlers/Per Wrestler
 -  $10.00
List School's Name
Discount For Second Child Per Family
 -  $10.00
Third Child Free Per Family..................................
 FREE
Make Checks Payable to Matrix Wrestling Club
Total Amount_______Cash ______ CHECK#_______
SEND TO: Matrix Wrestling, 3546 Broadway, ALLENTOWN, PA. 18104
PHONE: (610) 391-8915 ask for BILL ALLEN
WEB PAGE: http://matrixwrestlingclub.tripod.com/  
E-mail: mailto:matrixmatclub@yahoo.com    
Name:_______________________________________                         
Address:______________________________City____________________________   
State__________Zip:___________Telephone____________________
E-mail Address:________________________________
Grade______     Birth Date__________Age__________     Weight________
School_____________________________     
USA CARD NUMBER:__________
I grant permission my son/daughter to participate in the Matrix Wrestling program and agree to hold harmless all coaches, officers, and the __________________School District in the event of injury, which could occur during their participation in the sport of wrestling. Further, I/ we authorize the Matrix wrestling representatives to provide emergency treatment of injury and or illnesses of my/our child if qualified medical personal consider treatment necessary. This authorization is granted only if I/we cannot be reached.
Wrestlers Signature: _____________________ Date:_________
Parent/ Guardian Signature:___________________________               Date_______________