Level 4-6 ____ Entries X $70 = $_________

Level 7-10 ____ Entries X $85 = $_________

Team Competition

Level 4 ____ X $30 = $_________

Level 5 ____ X $30 = $_________

Level 6 ____ X $30 = $_________

Level 7 ____ X $30 = $_________

Level 8 ____ X $30 = $_________

Level 9 ____ X $30 = $_________

Level 10 ____ X $30 = $_________

Houston Team Cup ____ Teams X $330 = $_________

If paying before Jan. 9, 2005 deduct $5 per athlete = <$_________>

(Discount does not apply to the “Cup” competition)

If paying after Feb. 4, 2005 add $5 per athlete = $_________

Make your check out to “JCC”.

Total = $_________