1700 Mishawaka Ave., South Bend, in 46634

1-800-940-7469 1-855-754-9325 championforce.com SAT. APRIL 30, 3016 Held at the INDIANA UNIVERSITY SOUTH BEND 1700 Mishawaka Ave., South Bend, IN 46634 (Do not mail this form to event venue) Registration fees are non-refundable and non-transferable once received. DO NOT GIVE REGISTRATIONS OR PAYMENTS TO YOUR COACH. NEW! EARLY BIRD SPECIAL: $30. (if received or postmarked by deadline APRIL 21, 2016 at 5pm Registration fee: $40. (if received by APRIL 28, 2015 by 5pm) Registrations will NOT be accepted on Friday April 29, 2016. If you do not register before April 28, 2016, you will need to register at event Registration fee at the event: $50. Our trophy order is estimated by the total students registered prior to deadline. Please pre-register to alleviate trophy shortages. Competitor bands will no longer be mailed. Prepaid Competitor bands will be picked up and handed out by coaches at events. $2.00 Spectator Fee for those 12 and older. HOW TO REGISTER Register Online:Visa/Mastercard payments only accepted online: https://erp.championforce.com/onlineregistration (More instructions available online) *Champion Force is not responsible for incomplete online registrations. Register by Mail: This is only for those who need to pay for the event with CFA Bucks OR a Money Order. Fill out the registration form in full and send with CFA Bucks and/or Money Order made out to Champion Force. NO Checks will be accepted!

IN ORDER TO CREATE A SMOOTH RUNNING EVENT SCHEDULE, COMPETITION TIMES ARE CREATED ONCE COACHES SUBMIT TEAM SIZES, 4 WEEKS PRIOR TO EVENT. PLEASE INFORM YOUR COACH A.S.A.P. IF YOU WILL BE ATTENDING. Check in times, practice times, and performance times will be released 2 weeks prior to the event. This schedule will be posted on line at championforce.com, choose your state, and click “events”, and on Facebook – Champion Force of Indiana Payment & Liability Info (n-in) Fill out form completely and legibly, detach and mail with payment. Student Information Money Orders– by mail made payable to: Champion Force Visa/Mastercard payments only accepted online at: Name: ______https://erp.championforce.com/onlineregistration Address: ______Mail to: City: ______State: Zip: ______Champion Force Phone : ( ) Coach: ______(Indiana Northern) 165 54th St. SW Circle Division: 1 2 3 4 5 6 Wyoming, MI 49548 Circle Options: THE WAIVER BELOW MUST BE SIGNED FOR YOUR CHILD TO BE ELIGIBLE TO PARTICIPATE.  Name Plate/Trophy Label $5.00: Y N Champion Force, Inc, Liability Release: I, the parent of the student listed above, do hereby agree  Cross Compete (Div. 3 and up) $10.00 : Y N if yes which division:- to release all liability & claims against the Champion Force. organization & agree to hold harmless any liability against Champion Force., any sponsoring organization, facility, instructor and any _____ other party involved, due to any injuries, accidents, negligence, or any other circumstance arising  T- Shirt $15.00: Y N from participation in this program with respect to any time prior, during and after the class, including participation in all Champion Force events such as parades, performances, clinics, Size / Quantity: CS___ CM___ CL___ AS___ AM___ AL___ AXL___ competitions, demonstrations, tournaments, etc. Parents and/or CF may take photos or videos of AXXL___ classes, parades or special events for personal/company use. I understand my child may be Early Bird Registration by (4/21/16) $30. (+options) photographed. CF reserves the right to refuse service to any customer for any reason. $______Parent Signature: ______OR Registration between (4/22-4/28/16) $40 (+ options) $______1