CBRC Registration Form Back | Home
Name _________________________________________________________________________
Address _______________________________________________________________________
City _______________________ Zip __________ Sex: M or F (Please circle one.)
Phone _______________________________ Emergency Phone _________________________
Birth date _______________ Age _________ Grade ______________ School _________________________________________
Program __________________________________ Session I II (Please circle one.) Age Group ____________
Field/Center/Building/Location _____________________________________
Shirt Size (Does not pertain to all programs) Please circle correct size. NO EXCHANGES!
YS (6-8) YM (10-12) YL (14-16) AS (34-36) AM (38-40) AL (42-44) AXL (46-48)
Pictures (Does not pertain to all programs) I would like to purchase ______ picture packages at $10 per package.
Enclose a separate check or money order, payable to CBRC, for each registration. Please use separate forms and checks for each participant. Mail your check and registration form, or hand deliver, to CBRC, 2101 5th Ave , Altoona , PA 16602 . Registrations are accepted at the office Monday through Friday from 9:00 a.m. to 4:00 p.m. Visa, Master Card, check and cash are accepted at the office. No registrations are accepted by telephone or at the program site. A $5 late fee per registration and $2 late fee per picture package is charged after the program deadline.
Receipt No ______________
Scholarship _____________
Amount Pd______________
Chk_____ $_____ Chg_____