Competition Entry Form – Flipz Academy

Athlete Name

First

Last

Athlete Level

Athlete Birthdate

Parent/Guardian Contact E-mail

Parent/Guardian Phone

Competition Name

Competition Venue

Competition Date

Would you like to add Level test?

Level test fee applies

By signing this, I understand that after purchase, competition entry fee is partly refundable ONLY with medical certificate presented to SPC

Signature

Clear Signature

Competition Entry Fee (AUD)

Price: $5.00

$75 credit applied

Individual TRP - U13

Price: $21.00

Second apparatus

Total Amount

$0.00

Choose method of payment

Payer Name

First

Last

Payer Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Credit Card

Card

Name on Card