Judging Certification Know the Score! Registration Form

Please complete the following registration form if you are interested in attending our upcoming Judging Certification Course:

Judging Certification Course
June 16, 2012
Benedictine University
Lisle, IL
9am - 5pm
$150 (includes lunch)

Know the Score! Coaches Scoring Workshop
June 16, 2012
Benedictine University
Lisle, IL
12pm-5pm
$100 per person

Which certification course do you plan to attend? *

Contact Information

Full Name *

Email Address * 🛈

Address 1 *

Address 2

City *

State *

Postal Code *

Work Phone *

Cell Phone *

Please indicate your primary purpose for taking this certification course: *

Do you have any other judging certifications?

Yes

No

If you have judged in the past, please list those events below:

Are you interested in being a safety/deduction judge?

Yes

No

Possibly

What type of lunch would you prefer?
(Lunch is included in the price of the course for Judging Certification only) *

Total Registration Fee Due: *

Do you plan to pay your registration fee via check? *

Yes

No

If you are paying by check please mail a copy of this registration form (with full payment) to:

Champion Spirit Group
Judging Certification
245 W. Roosevelt Road

Building 1, Suite 5
West Chicago, IL 60185

If you would like to pay your registration fees via credit card, please enter your card information in the space provided below.

Name on Card

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Credit Card Type

Credit Card Number

CSC Code 🛈

Expiration Date (mm/yy)

Credit Card Authorization

I hereby authorize Champion Spirit Group to charge my credit card for the amount listed above + a 3% processing fee..