NJCDCA Recreation States Registration
PLEASE READ ALL BULLETS BELOW BEFORE COMPLETING THIS FORM!!!

* Please complete ONE form for each team entry. Multiple performances will require multiple forms to be completed.
* You cannot make changes to this form once you've submitted. If you need to make changes, please contact Kimberly McGowan directly prior to the first mandatory meeting!
* All questions must be completed before you can advance to the next section of the registration form.
*When this form is complete, a confirmation will be emailed to you. Please print and use the confirmation email as your invoice, and send in with your PO, check, COI, team rosters, and waivers. If a more detailed invoice is needed, please visit the Forms Page on njcdca.com.
** Please Mail Checks/POs, team rosters, Certificates of Insurance (naming the NJCDCA and Brookdale Community College as additional insureds), and individual athlete waivers to Pat DePalma, 196 Ambermist Way, Forked River, NJ 08731. Questions about registration? Please contact Pat via email at padepalma@aol.com
**Please make checks payable to NJCCA. A $100 Late fee will apply if registered after January 17th. No Registrations will be accepted after January 24th. NO EXCEPTIONS.
**IF YOU DO NOT RECEIVE A CONFIRMATION EMAIL WITHIN 24 HOURS YOU SHOULD CONTACT Pat DePalma TO BE SURE YOUR REGISTRATION WAS RECEIVED.
Email address *
Organization Name *
Your answer
Organization Address *
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Organization City *
Your answer
Organization Zip Code *
Your answer
Organization Phone Number *
Your answer
Number of Competitors *
Your answer
Number of Alternates *
Your answer
Number of Males *
Your answer
Number of Females *
Your answer
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