CLUB NAME:______Kettle Run Wrestlng Club ____________________________________________________
Choose Request: 1) Deposit to NVWF 2) Check from NVWF
Amount__$______750____________________________________________________________________________
(send only one Club Check for total registrations, not one personal check from each parent*)
Reason: _____Host Fee for 1/6/19____________________________________________________________________
(number of Wrestlers and if LateFee)
OR (date and location of Tournament)
FOR CHECK REQUESTS:
(include copies of contracts or receipts)
Payable to:_______Kettle Run Wrestling Club________________________________ date__1/1/19________
Mailing Address:_______6256 Mint Spring Drive, Warrenton, VA 20187_______________________
Contact Name & Phone Number: ______Jana Bresson 540-222-2956____________________
Send this form; 1) alone with your club’s registration check for deposit* …OR FOR
2) reimbursable with receipt, 3) $750.00 Host Feetwo weeks before your meet date, and
a separate form for 4) the $300.00 athletic trainer fee to:
NVWF Treasurer
c/o James Zoller 6329 Bob White Drive
Warrenton, VA 20187
(*This form is used to send or request monies only, do not send with Registration Forms.)