| Date Submitted:* |
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| Team Name: * |
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Men's Class:*
(Elite / Gold / Silver / Bronze) |
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| NSA Sanction Number: * |
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| State Director:* |
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Where did
Your Team Qualify?: * |
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| Date Qualified: * |
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| Location Qualified: * |
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| Manager Name: * |
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Manager's Mailing
Street Address: * |
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| Manager's City: * |
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| Manager's State: * |
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| Manager's Zip Code: * |
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| Manager's EMAIL: * |
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| Manager's Day Phone: * |
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Manager's
Evening Phone: * |
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NSA Super World
Location Entering: * |
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NSA Super World
Tournament Date: * |
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Select ONE:*
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My Team has VALIDATED their berth |
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My Team has NOT VALIDATED their berth yet, but plans to.
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CHECK OFF AFTER *
READING STATEMENT:
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I have read and agree to the beginning statement
as the representative for my team.
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Money Order
or Cashiers Check:
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Make Payable to: NSA
Personal or Company/Sponsor Checks will NOT be accepted!
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Payment by Charge:
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Contact Sonja at 859-887-4114
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Send by
Postal Service:
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NSA - Super World
PO Box 7
Nicholasville, KY 40340
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Send by
UPS or FED-EX:
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NSA - Super World
101 NSA Way
Nicholasville, KY 40356
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Enter Payment Type &
Check Numbers: |
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