Quad RugbyInvite - Under 22 Registration Forms

UNITED STATES QUAD RUGBY ASSOCIATION

June, 2005

USQRA 22 and Under National Training Camp
July 27-30, 2005 - Tucson, Arizona
Hosted by The University of Arizona Adaptive Athletic Program

Registration Form

Personal Information

Participant’s Name_________________________ Birth date________________

Address______________________________ Email______________________

City__________________________ State_________ Zip__________________

Phone(s) ______________________________________________________

Disability type/level or USQRA Class____________________________________

Do you have any medical complications and / or allergies that we should know about?

__________________________________________________________________

Emergency Contact Information

Name ___________________________ Relationship _____________________

Phone (Day) ______________ (Evening) _______________ (Cell) ______________

Registration Deadline: July 1

Transportation Information: Driving ______ Flying _____

For Flights:

All camp attendees need to arrive at Tucson by 6 PM July 27^th and should not leave before 2 PM July 30^th.
Once you do receive your flight info, please fax that to Mike Cottingham at (520) 621-9421 before July 10th.

Camp Specifics

Entry fee is $100 for USQRA members and $175 for non members, and will cover housing, all meals Wednesday evening thru lunch Saturday, coaching, facilities, and ground transportation.

Preferred Roommate _____________________________________________

* If you are bringing a personal attendant to assist you it will be $112.50 for three nights stay and all their meals covered (this is at cost).

All rooms will have access to an ADA accessible shower, bathroom and bedroom. If you need additional accommodations please describe:
__________________________________________________________________

A repair station will be provided and tires and tubes will be for sale, but each athlete should bring at least one additional rim in case of a flat so as to not lose time.

If you do not have a rugby chair please contact me and we will provide a chair for you for this event.

All registration forms are to be sent to (prior to registration deadlines):

Mike Cottingham

1224 E Lowell Street

P.O. Box 210095
Tucson, AZ 85721

Questions regarding the camp should be directed to

Mike Cottingham (520) 661-4634
Email azwheel19@aol.com

Hit Counter

How to Contact us | Quad Rugby Central Index