2010 TBCA State Clinic Registration Information

MAIL THIS FORM TO:

TBCA Clinic 150 Timberland Drive, Livingston, TN 38570

Make checks payable to: TBCA Clinic

Head Coach Name:_______________________________________________

Assistant(s) attending_______________________________________________________

______________________________________________________________

School/Organization:_______________________________________________

Address:______________________City:______________State____Zip______

Registration:              Member of TBCA $65 (before January 8^th, 2010)_____________

Non-Member             $85(before January 8^th, 2010)_____________

Registration:              After January 8^th and at door will be $85 for members and $105 for non-members.

If you need an email confirmation, put address here:______________________