2018 REGIONAL CONGRESS

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1 REGISTRATION DETAILS This form is for 2018 NAWGJ Regional Congress registration ONLY In order to take advantage of the NAWGJ group tiered pricing, each individual registered MUST be a USA Gymnastics Professional or Jr. Professional, and rated Judge and NAWGJ member. One payment is accepted for all registrants. Please be sure to include name and valid address for each registrant INDIVIDUAL REGISTRATION INCLUDES: Regional Congress credential for access to educational sessions during the 2018 Regional Congress event Access to Regional Congress Trade Show Hall Current Members will receive USA Gymnastics University credit and U310 course certificate USA Gymnastics CPE credit Attendee Gift For more information please visit USAGymnasticsUniversity.org. For accommodations please visit National Travel Systems at ntssportstravel.com NAWGJ INFORMATION (please print. All fields required.) 2018 REGIONAL CONGRESS N A W G J R E G I S T R A T I O N F O R M REGION 1 CONGRESS August San Jose, CA REGION 5 CONGRESS Sept , Louisville, KY REGION 2 CONGRESS June 30-July 1, Beaverton, OR REGION 6 CONGRESS National Congress REGION 3 CONGRESS June 16-17, Dallas, TX REGION 7 CONGRESS National Congress REGION 4 CONGRESS June 15-17, St. Louis, MO REGION 8 CONGRESS June 8-10, Winston Salem, NC State NAWGJ Director Name. Contact Address Phone. Contact Address. PAYMENT INFORMATION (please print. All fields required.) Make checks payable to USA Gymnastics. Send completed forms to: (Mail) USA Gymnastics, 130 E. Washington St., Suite 700, Indianapolis, IN (Fax) ( ) education@usagym.org Credit Card Expiration. Print Cardholder Name. Signature. Billing Address. Payor Address Payor Phone. PAYMENT TOTALS Regional Congress Attending. Total Registrants Total Banquets (if applicable) Total Amount Due. CANCELLATION/SUBSTITUION POLICY There is a $30.00 cancellation fee up until 2 weeks prior to the first event day. NO REFUNDS AFTER THIS DATE. Cancellation request must be received in writing to education@usagym.org. Refunds will be based on the lowest paid registration amount. Substitution of participants will be allowed until 2 weeks prior to the first event day at no charge if submitted in writing to education@usagym.org. On-site substitutions will be charged a $30.00 transfer fee. OFFICE USE ONLY Postmarked Payment Check # Authorized Date

2 REGISTRANT 1 OFFICE USE ONLY: REGISTRATION # $. Region 1 Price - $155 (Deadline ) Price - $185 (Deadline ) N/A Region 2 Price - $135 (Deadline ) Price - $165 (Deadline ) N/A Region 3 Price - $135 (Deadline ) Price - $165 (Deadline ) N/A Region 4 Price - $155 (Deadline ) Price - $185 (Deadline ) N/A Region 5 Price - $155 (Deadline ) Price - $185 (Deadline ) $50.00 Region 8 Price - $155 (Deadline ) Price - $185 (Deadline ) $50.00 REGISTRANT 2 OFFICE USE ONLY: REGISTRATION # $. Region 1 Price - $145 (Deadline ) Price - $175 (Deadline ) N/A Region 2 Price - $125 (Deadline ) Price - $155 (Deadline ) N/A Region 3 Price - $125 (Deadline ) Price - $155 (Deadline ) N/A Region 4 Price - $145 (Deadline ) Price - $175 (Deadline ) N/A Region 5 Price - $145 (Deadline ) Price - $175 (Deadline ) $50.00 Region 8 Price - $145 (Deadline ) Price - $175 (Deadline ) $50.00 REGISTRANT 3 OFFICE USE ONLY: REGISTRATION # $. Region 1 Price - $135 (Deadline ) Price - $165 (Deadline ) N/A Region 2 Price - $115 (Deadline ) Price - $145 (Deadline ) N/A Region 3 Price - $115 (Deadline ) Price - $145 (Deadline ) N/A Region 4 Price - $135 (Deadline ) Price - $165 (Deadline ) N/A Region 5 Price - $135 (Deadline ) Price - $165 (Deadline ) $50.00 Region 8 Price - $135 (Deadline ) Price - $165 (Deadline ) $50.00

3 REGISTRANT 4 OFFICE USE ONLY: REGISTRATION # $. Region 1 Price - $125 (Deadline ) Price - $155 (Deadline ) N/A Region 2 Price - $105 (Deadline ) Price - $135 (Deadline ) N/A Region 3 Price - $105 (Deadline ) Price - $135 (Deadline ) N/A Region 4 Price - $125 (Deadline ) Price - $155 (Deadline ) N/A Region 5 Price - $125 (Deadline ) Price - $155 (Deadline ) $50.00 Region 8 Price - $125 (Deadline ) Price - $155 (Deadline ) $50.00 REGISTRANT 5 OFFICE USE ONLY: REGISTRATION # $. Region 1 Price - $115 (Deadline ) Price - $145 (Deadline ) N/A Region 2 Price - $95 (Deadline ) Price - $125 (Deadline ) N/A Region 3 Price - $95 (Deadline ) Price - $125 (Deadline ) N/A Region 4 Price - $115 (Deadline ) Price - $145 (Deadline ) N/A Region 5 Price - $115 (Deadline ) Price - $145 (Deadline ) $50.00 Region 8 Price - $115 (Deadline ) Price - $145 (Deadline ) $50.00 REGISTRANT 6 OFFICE USE ONLY: REGISTRATION # $. Region 4 Price - $100 (Deadline ) Price - $125 (Deadline ) N/A Region 5 Price - $100 (Deadline ) Price - $125 (Deadline ) $50.00 Region 7 Price - $100 (Deadline ) Price - $125 (Deadline ) $50.00

4 REGISTRANT 7 OFFICE USE ONLY: REGISTRATION # $. REGISTRANT 8 OFFICE USE ONLY: REGISTRATION # $. REGISTRANT 9 OFFICE USE ONLY: REGISTRATION # $.

5 REGISTRANT 10 OFFICE USE ONLY: REGISTRATION # $. REGISTRANT 11 OFFICE USE ONLY: REGISTRATION # $. REGISTRANT 12 OFFICE USE ONLY: REGISTRATION # $.

6 REGISTRANT 13 OFFICE USE ONLY: REGISTRATION # $. REGISTRANT 14 OFFICE USE ONLY: REGISTRATION # $. REGISTRANT 15 OFFICE USE ONLY: REGISTRATION # $.

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