Northern Division Registration & Invoice Form
2005
Western Region FIS Devo Series
Men & Women Mammoth Mountain
Dec 17-Dec
23, 2005
Name: __________________________________________
Address: ________________________________________
________________________________________________
Phone: __________________________________________
Email: ___________________________________________
Travel:
| Fly_______ Drive_______ (check one) |
|||
|
To/From: |
With ________________ |
||
| Arrive date:________ | Arrive time:________ | Flight:________________ | Airline:_______________________ |
| Depart date:_______ | Depart time:_______ | Flight:________________ | Airline:_______________________ |
Fees:
|
Expense |
Per athlete cost |
|
Lodging |
$275.00 |
|
Coach and staff support expenses |
455.00 |
|
Entries |
140.00 |
|
Lifts |
200.00 |
|
Administration Fee |
20.00 |
|
Total Due |
$1090.00 |
Check NO.
_______________________
Mail to: Jenn Stielow, Northern Division/USSA
574 Bighorn Circle # BRR Silverthorne,
CO. 80498
**Please note this is an
estimated cost amount. Final costs will
be posted on the web site www.northernussa.org. You will be sent a credit/debit invoice after
the races. Credits will be applied to
the next race and payments must be submitted upon receipt in order to continue
to travel with Northern Division during the season.