Name(s):________________________________________________________________________
Date of Birth:_________________________ Phone Number:________________________
Street Address: __________________________________________________________________
City, State, Zip: _________________________________________________________________
E-mail Address: _________________________________________________________________
Parent/Guardian Name(s): ________________________________________________________
Alternate Contact Number: _______________________________________________________
American Vaulting Association (AVA) Membership Fee:
Number of Vaulters: ____ X $50 Annual AVA (competitive) Membership = $___________
Number of Vaulters: ____ X $25 Annual AVA (recreational) Membership = $___________
Root Farm Monthly Dues:
Active Individual: $75...………………………………......................……...………… $___________
Active Family: $140.………………………………………….......................…….…$___________
Total Due (1st Practice is FREE):
$___________
