Place:

Mauston Wrestling Clinic

May 6, 2007

TEAM MIDWEST EXTREME WRESTLING CAMPS

Registration for Mauston Clinic

NAME:

E-MAIL ADDRESS:

ADDRESS:

CITY/STATE/ZIP:

TELEPHONE:

GRADE THIS FALL:

As the parent/legal guardian of the above named athlete, I understand and agree that the Mauston Public Schools, the Midwest Extreme Wrestling Club and its clinicians, and anyone else connected with the facilities used assume no responsibility for accidents, injuries, medical, or dental expenses incurred by my son/daughter while participating in this program.

Parent or Legal Guardian’s Signature                                                                                       Date

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For More Information, Please contact either of the following:

-- Tom Miller at (608) 666-2151 or e-mail tm9196pin@yahoo.com

-- Billy Huebner at (608) 790-2468                                                              

REGISTRATION:

Registration will be at the door.  If you’d prefer to pre-register, please complete the registration form below and send it with your camp fee to Tom Miller, W3137 US Hwy. 12 & 16, Lyndon Station, WI  53944.  All pre-registration forms are due by May 3, 2007. Checks should be made payable to:  EAGLE EXTREME WRESTLING CLUB.

WHO:

time:

cost:

Mauston High School

Wrestlers in grades K-12

2:00 - 5:00 p.m.

$30

Camp fee includes T-shirt.

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