| Club name: ______________________________________ | Province: ________________ |
| Address: (street) ___________________________________________________________ (P.O. Box) ________________________________________________________ (Town/City) _______________________________________________________ (Postal Code) ______________________________________________________ Team manager: _____________________________________________________ Telephone: ________________________________________________________ Fax: _____________________________________________________________ E-mail: ___________________________________________________________ |
| Total # of gymnasts: _________________________________________________ Total # of coaches: __________________________________________________ Total # of team managers: _____________________________________________ Total # of parents/chaperones: __________________________________________ Total # of delegation: _______________________________________________ |