Regional Future Stars andTechnical Sequence Evaluation

October 13/14, 2018ST Charles Gymnastics Academy

ST Charles, IL

Deadline for Entries: Wednesday, September 26, 2018Entries received after deadline will have a $10/gymnast added to the total due.

* Age division determined by December 31, 2018.

Registration Form

CLUB NAME PHONE # CLUB’S USAG # CONTACT EMAIL

COACH NAME USAG # SAFETY EXP

GYMNAST’S NAME USAG # BIRTHDAY * AGE DIV

FS or TS

# OF GYMNASTS ________ X $60.00 = ___________________________ Entry Deadline: Wednesday, September 26, 2018

Please send checks payable to: Region 5 Men’s Gymnastics Mail to: Region 5 Men’s Gymnastics

Attention Kenny Gesiakowski / ST Charles Gymnastics720 N. 17th Street, ST Charles, Illinois 60174