Date: May 15th, 2010

Time: 11AM

Location: Mansfield High School Gymnasium

Website: www.mhstrack.com

Contact Info: derekellis74@gmail.com

Stackers will have the opportunity to compete in all three individual events and one relay event.

• Individual Events: 3-3-3, 3-6-3, and Cycle. (refer to: www.speedstack.com for rule changes and you are allowed to use your own speedstacks)

• Table Relay Event: Timed 3-6-3 (4 person teams)

Stacker’s Name:________________________________________________________

Home PH# _______________________________ Age on 5/15/10:_______________

Age Divisions (circle one): 7, 8, 9, 10, 11

Parent/Guardian Name: ___________________________

Email Address: _____________________________

If you are on a relay team please fill out the information below.

Relay Team Name: ________________________Coach: __________________

Coach PH #: ________________________ Email: _______________________

______________________________________________________________________

Registration Fee: $15.00

*Please pass in registration fee and form to Mr. Lambert or Mr. Ellis by May 7th

*Please make all checks payable to Mansfield Boosters

______________________________________________________________________

Parent/Guardian Agreement: I understand that my child will need to be supervised during the competition. Either my child’s Relay Team Coach or I will assume this responsibility.

Signed: _____________________________________ Date: _________________

* T-shirts will be available for $15.00 on the day of the competition.