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COBRA WRESTLING SYSTEMS
Cobra Wrestling Systems
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CAMP REGISTRATION (click here)
*
CAMP TOPIC ATTENDING:
*
Traveling with the Cobra Travel Team; yes or no:
Select One
No
Yes
*
DATE ATTENDING:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2023
2024
*
CAMP LOCATION:
*
WRESTLER'S FIRST NAME:
*
WRESTLER'S LAST NAME:
*
AGE:
Select One
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22 plus
*
WEIGHT:
Select One
30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
125
130
135
140
145
150
155
160
165
170
175
180
185
190
195
200
205
210
215
220
225
230
235
240
245
250
255
300
*
WRESTER'S CLUB/SCHOOL TEAM:
USA Wrestling Card No #:
*
PARENT OR GUARDIAN NAME:
*
Phone Number: for example 503-123-4567:
*
EMAIL ADDRESS:
*
Street Address:
*
City:
*
State:
*
Zip Code:
Medical Insurance:
Group/Policy #:
Electronic signature, I am the legal guardian to the participant and by checking the box I agree to Cobra Wrestling Systems Registration and Waiver.
*
VISA CARD NUMBER (or call 503-956-7022):
VISA 3-digit PIN NUMBER (or call 503-956-7022):
VISA CARD HOLDERS NAME (as it appears on the card):
VISA EXPIRATION DATE:
VISA CARDHOLDERS ZIP CODE:
VISA AMOUNT CHARGED $:
PLEASE CALL WITH ANY QUESTIONS.
COACH SPRAGUE
503-956-7022
* indicates required fields