NORTH CAROLINA CONFERENCE OF TEMPLES AND COURTS

Ancient Egyptian Arabic Order Nobles Mystic Shrine

Of North and South America and Its Jurisdictions, Inc.

YOUTH DEPARTMENT

Jump Robe / Step Team Competition

2010 REGISTRATION FORM

(Please print or type)

COURT / TEMPLE NAME_______________________________________ NO ______________

ADDRESS_____________________________________________________________________

CITY__________________________________________ STATE________ ZIP______________

TEMPLE / COURT DIRECTOR / DIRECTRESS NAME, PHONE NUMBER AND EMAIL ADDRESS

Name_________________________________________________________________________

Phone No.______________________________________________________________________

Email__________________________________________________________________________

Number of members on team____________________

Units will not be permitted to participate if the forms are not received or completed correctly.

Please complete separate sheet for each unit.

Director / Directress:

_______________________________________________________________________________

How many Youth – Age _____13 _____14 _____15 _____16 _____17

_____6 _____7 _____8 _____9 _____10 _____11 _____12

PLEASE RETURN FORM BY MAY 15, 2010 TO: Dt. Sylvia D. Little (90)

1926 Wheatfield Court

Greensboro, NC 27405

336-558-1421