Name of Coaches attending
Home Address :

Name of School:
School Address:

Home Phone:
Cell Phone:
E-Mail:
Desired Camp and Date:
Number of Students attending (male):
Number of Students attending (female):
A deposit of $50 per student is required to confirm registration. Please mail check to Kansas NCA/DA, 4216 Wimbledon Drive, Lawrence, KS., 66047. We will send packet prior to deposit upon request.

 
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