USACK membership # required:
Payment:
American Slalom Excellence Program
Registration Form: please check training camp/s you are signing up for:
□ Week #1 ________ US Cup Races & Training Camp
Wisconsin R., Wausau, WI
□ Week #2 _________ Junior Olympics/US Cup Race & Training Camp
East Race Waterway, South Bend, IN
Name: _____________________________________________________
Street / Mailing Address:________________________________________
Town, State, Zip: _____________________________________________
Date of Birth: ___________________ Age: ______________ M/F: ______
Home Phone: _______________________________
Work phone: _______________________________
Mobile Phone: ______________________________
Email: _____________________________________
Circle your Whitewater Slalom boat/s that you will paddle and race:
C1, K1, and/or C2 including your C2 Partner's Name: __________________________
How did you hear about the American Slalom Excellence Program?
What class of whitewater are you most comfortable paddling?
Do you have a solid whitewater river roll?
How often do you train for whitewater slalom?
Do you keep a training log or journal?
What are your whitewater slalom racing goals?
Other information the coaches should know about you:
Please return the 5 forms & coaching fees payable to "David Hearn".
6211 Ridge Drive, Bethesda, Maryland 20816-2641 USA
Please mail the 5 completed forms & include a $100 non-refundable deposit to reserve
limited space in the American Slalom Excellence Program by _____, 2006.
Final payment is due ______. Thank you!
updated 08/11/05
