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2009 CONTROL LINE COMBAT TEAM SELECTION ENTRY FORM

September 5,6, & 7, 2009

Lubbock, Texas

NAME:______________________________________  AMA #________________________ JR   SR   OPEN

ADDRESS:_____________________________________  DAY PHONE:  ________________________

              _____________________________________  EVENING PHONE:  ____________________

              _____________________________________

EMAIL ADDRESS:  ___________________________________________________________________________

SIGNATURE:  ______________________________________________________________________________

_________    EARLY ENTRY FEE $75.00

_________    ON-SITE ENTRY FEE $100.00

_________    PROGRAM ENTRY FEE $25.00

MAKE ALL CHECKS PAYABLE TO AMA.

CREDIT CARD NUMBER ______________________________________________________________________

EXPIRATION DATE_________________________________

If this form has been embossed with the AMA seal, payment has been received at Headquarters.

Print this form, fill it out, and mail to AMA with entry fee.

MEARS MAZDA VOLVO LUBBOCK, TX