2008 HUDSON VALEY CHALLENGE COACHES REG FORM

LAST NAME ____________________ FIRST NAME ___________________ M.I ______

ADDRESS _____________________________________________________________

CITY ____________________ STATE _________________ ZIP __________

HOME # ( )____________________ WORK # ( )____________________

CURRENT RANK (if any) _________________________

AAU District _________________________ AAU # (Required) _________________________

DATE of BIRTH / / AGE _____ Certification Number ___________________________

LAST CERTIFICATION CLINIC ATTENDED ______________________________________

TAEKWONDO SCHOOL AFFILIATION:

SCHOOL NAME _______________________________________________________________

SCHOOL ADDRESS ____________________________________________________________

HEAD INSTRUCTOR ___________________________________ Phone # ( ) ____________

I understand that coaches must be properly attired to AAU Rules (Royal Blue AAU Official

Coaches Shirt and athletic pants) and that in order to be on the competition floor;

I MUST attend a coaches clinic at the District or Regional level prior to the date of

competition and have my clinic participation card in hand at the clinic.

Signature: ___________________________________

Coaches Fee for the Event: $15.00

Please Make all Money Orders Or Bank Checks Out To (Robert Blum)