Please print this form...
2003 Midwest Conference Dues Form
(NORDIC)
School
_________________________________________________________________________
Coach/Advisor__________________________Phone________________E-mail___________________
Contact #1
__________________________Phone__________________E-mail___________________
Contact #2
__________________________Phone__________________E-mail___________________
Permanent Campus Address
____________________________________________________________
City
__________________________________ State ______________________ ZIP ______________
Division (circle
one): CHICAGO
OHIO MICHIGAN LAKE SUPERIOR
Please complete BOTH FORMS completely and accurately and return with proper fees to the address
below. These forms are for the conference dues and are not part of the National fee structure!!! The money
from this registration forms is used for the actual operation of the races and associated fees and costs.
This fee also includes the secondary insurance policy which is required by the race hills.
All registered racers MUST pay the fee and be listed to be included on
the insurance policy.
TEAMS MUST ALSO PAY THE $110 NCAA MEMBERSHIP FEE
DETAILS TBA
The 2003 structure for Midwest Conference fees is as
follows:
______ # of racers (First 20 racers) X
$35
$_______________
______# of racers (Additional racers) X $20 $_______________
_______________________
AMOUNT
ENCLOSED:
$_______________
Return this form along with your fees by November 23th, 2004 to:
Midwest Collegiate Ski Association
2110 Troy Lane
Plymouth, MN 55447
NOTE: If you HAVE NOT RECEIVED your national due and eligibility forms yet, you MUST
contact the National Office at (952) 249-0568 or via e-mail.
YOU MUST HAVE YOUR NATIONAL DUES IN TO RACE!
RACER ROSTER
School Name _______________________
All members must be LISTED AND PAID!
NUMBER RACERS NAME (Please print legibly) PAID
1
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2
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3
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4
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5
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30
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USE ADDITIONAL PAPER IF NECESSARY