2018 Medium Group (4-10 participants) Registration $100
The Corners of Brookfield, Wisconsin – Saturday September 29, 2018.

Please complete payment on paypal here: http://bit.ly/2seg8RJ

ABOUT PARTICIPANT 1
1. Name *
Your answer
Date of Birth *
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Grade Enterting in Fall *
Hometown *
Your answer
Any Health Concerns to be Noted *
Your answer
ABOUT PARTICIPANT 2
2. Name *
Your answer
Date of Birth *
MM
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DD
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YYYY
Grade Enterting in Fall *
Hometown *
Your answer
Any Health Concerns to be Noted *
Your answer
ABOUT PARTICIPANT 3
3. Name *
Your answer
Date of Birth *
MM
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DD
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YYYY
Grade Enterting in Fall *
Hometown *
Your answer
Any Health Concerns to be Noted *
Your answer
ABOUT PARTICIPANT 4
4. Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade Enterting in Fall *
Hometown *
Your answer
Any Health Concerns to be Noted *
Your answer
ABOUT PARTICIPANT 5
5. Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade Enterting in Fall
Hometown
Your answer
Any Health Concerns to be Noted
Your answer
ABOUT PARTICIPANT 6
6. Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade Enterting in Fall
Hometown
Your answer
Any Health Concerns to be Noted
Your answer
ABOUT PARTICIPANT 7
7. Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade Enterting in Fall
Hometown
Your answer
Any Health Concerns to be Noted
Your answer
ABOUT PARTICIPANT 8
8. Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade Enterting in Fall
Hometown
Your answer
Any Health Concerns to be Noted
Your answer
ABOUT PARTICIPANT 9
9. Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade Enterting in Fall
Hometown
Your answer
Any Health Concerns to be Noted
Your answer
ABOUT PARTICIPANT 10
10. Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade Enterting in Fall
Hometown
Your answer
Any Health Concerns to be Noted
Your answer
ABOUT YOUR PERFORMANCE
Talent Show you will be competing in *
Name for your Performance Piece *
Your answer
Estimated Time of Performance (all performances must be 3 minutes or less) *
Your answer
PARENT CONTACT
Guardian Name *
Your answer
Relationship *
Your answer
Emergency Contact for Day of Event *
Your answer
Phone Number *
Your answer
DETAILS
Best Email Address to Pass Along Details for Event *
Your answer
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