Team USA Clinic Registration
Parents and Anglers,

Please take a few moments to complete the questions below. Afterwards, submit payment following the directions provided at document's end. Clinic registration is first come, first served.

First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Youth Angler Phone *
Your answer
Youth Angler email *
Your answer
Emergency Contact *
Your answer
Emergency Phone *
Your answer
Parent/Guardian name *
Your answer
Parent/Guardian Mobile Phone *
Your answer
Parent/Guardian email *
Your answer
Youth Angler Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Food/insect/medical allergies or special needs *
Your answer
Number of clinics attended *
Number of competitions completed *
Tell us about your nymphing experience *
Your answer
Tell us about your suspension techniques experience (dry dropper, indicator, etc.) *
Your answer
Tell use about your casting experience. How far can you cast? How accurately? *
Your answer
Fly tyer? *
Required
T-shirt size (Adult sizes) *
Payment Information *
Required
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