1 999 CONGRESS ADD·ONS REGISTRATION FORM
DATE RECV'D AMT. PD. CHECK #
No Pre-Registration after August 13 After August 13 you must register on-site for a $25 additional late fee per course per person
POSTMARK DEPOSIT CRCD APP #
NOTE: Due to limited space and materials, admission to Congress add-ons is not guaranteed unless pre-registeredo Due to time constraints, severa l courses may overlap. Please be aware of this when scheduling add-ons.
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Use this form to register for the 1999 Congress tests, examinations, certifications, etc. One form per person . Photocopy for additional add-on registrations. NOTE: Your Pro Address (listed in the USA Gymnastics member database) will be used for all correspondence.
Name . Birth date
. . . . ... w...... .......... ... Social Security No ......
Safety . Exp.oate ................_
USA Gymnastics Pro/ lnst. # ......................................................... USATI #
o THIS IS ANEW ADDRESS
Mailing Address ... City ....
. .............................................. State ..
Day phone (
..................... Zip . Night phone (
Check appropriate space for the add-ons you wish to attend. INST. PRO NON SUB MEMBER MEMBER MEMBER TOTAL
INST. PRO NON SUB MEMBER MEMBER MEMBER TOTAL
SAFETY CERTIFICATION COURSES Minimum age for Safety Certification is 17'/2
Wed. August 25, 1·5 pm
a For remts. MUST be currently safety certified AND a pro-member. a For those not already safety certified.
$50 $50
$0 $50
$1000 $100 0
$50 $50
$0 $50
$1000 $100 0
Sun. August 29, 9·1 pm
a For remts. MUST be currently safety certified AN Da pro-member. a For those not already safety certified.
PROFESSIONAL DEVELOPMENT PROGRAMS Levell Video Clinics
a Wed. August 25, 1-4 pm Course #1 a Sun. August 29, 9-12 noon
$10
$10
$10
$10
Course #2 ASEP COACHING PRINCIPLES COURSE a Wed. August 25, 9 am-6 pm NOTE: Enrollment limited, Pre-registration required.
$70
$70
KINDER ACCREDITATION FOR TEACHERS (KAT) a Wed. August 25, 9 am-6 pm $140 NOTE: Pre-registration guarantees a KAT Workbook. Enrol/ment is limited.
$140
ATHLETE WELLNESS COURSE (AWC) a Sun. August 29, 8 am-l pm Participants must register by July 31 so the textbook, The Athlete WeI/ness Book, can be sent in advance. This year's course will focus on practical applicotion of textbook material with increased time for question and answer and small group discussion. See page 39 for course details.
$50
$50
$1000
NOTE: Ex(ept for Ihe AACCA, Add·On porticiponls do NOT need 10 olso be registered for the 1999 Congress.
AACCA (CHEER) CERTIFICATION FOR USA GYMNASTICS COACHES a Fri. August 27, 3-6: 15 pm For registration form contact AACCA at 1-800-533-6583 or email atlvargym@aol.com Send $55 payment to AACCA. $10 0 1 - - - - - - -- - -- - - - --PROGRAM COURSES $10 0 Women's Skill Evaluator Examination a Sun. August 29, 9-10:30 am $9 $150 Women's Judges Certification Exams a Sun. August 29, 8-12 noon Registration form is in NAWGJ Newsletter. $800 Send payment to ](1 by August 6, 1999. Rhythmic Judging Course Exams (written) a Sun. August 29, 9-11 am - All levels $20 $200
OTAL PAYMENT $1600
Minimum age is 16.
Please return this registration form to: USA Gymnasti(s Congress Pan Ameri(an Plaza, Suite 300, 201 South Capitol Indianapolis, IN 46225 FAX: 317·237·5069 ATTENTION: TIna Sunier
MAKE CHECK/MONEY ORDER PAYABLE TO USA GYMNASTICS Amount Enclosed Charge to:
1 .....$______1 ~
0 VISA
0 Discover 0 Mastercard
PREFERS
VISA'
0 Amex
Card No . . Exp . Date ... Signature
MORE ADD·ONS CONTtNUED ON PAGE 39
LANGUAGE: The Officiol Longuoge of Ihe 1999 Congress is English. USA Gymnosli(s will moke no speciol provi· sions for tronslolion of sessions inlo olher longuoges. VIDEOTAPING: Videoloping of Congress Add·On sessions is permiNed FOR PERSONAL USE ONLY unless the individuol Session Presenters onnoun(e Ihol his/her/lheir session moy not be videoloped. CONGRESS AnENDEES WITH SPECIAL NEEDS must notify USA Gymnosti(s (in wriling) in Ihis regord prior 10 Ihe July 31 pre·registrotion deodline. We suggesllhol this infor· motion be included wilh Ihe Congress Add·On Pre·registrotion Form.