Central States Shrine Clown Association - Registration Form
August 28, 29 & 30, 2008

Name: _____________________________________

Ladies Name: _____________________________
Clown Name: _______________________________

Shrine Center: ____________________________
Date of Birth: _____________________________
Address: ___________________________________
City: _____________________________________ State: ______ Zip Code: _________

E-mail address______________________________@ _____________

                     (PLEASE PRINT CLEARLY)
(Confirmation of registration will be sent to those who provide an e-mail address)

Competition Information: (Please circle your choice)
Make-up & Costume Class:

Whiteface Auguste Tramp Character Hobo

Divisions: Open  Senior (60 + years)  Rookie *
*Rookie competitors: The certificate form must be signed by the unit President or director, and by the competitor. Attach signed certificate to registration.

Balloon Competition: Yes__ Single__Multiple__No__
Skit Competition: Individual____, 2 Man_____, 3 to 5 Man_____, Unit_____
_______________________________________________________________________
Early Registration Late Registration or Walk-ins
Letters post marked Letters Post-marked
August 13 or earlier
_____$50.00 Per Clown for Competition & Banquet
_____$75.00 Per Clown & Lady, Competition & Banquet

_____$25.00 Per Non-competing Clown, Lady or Guest, Banquet only
_____$15.00 Per Couple or $10.00 for Individual – FRIDAY NIGHT Cook-Out

August 14 or later

_____$75.00 Per Clown for Competition & Banquet
_____$110.00 Per Clown & Lady, Competition & Banquet

_____$50.00 Per Non-competing Clown, Lady or Guest, Banquet only
_____$15.00 Per Couple or $10.00 for Individual – FRIDAY NIGHT Cook-Out

Please Make Checks Payable to: CSSCA 2008

Total Enclosed: $________

Please mail to:
CSSCA 2008
C/O Larry W Love
PO Box 12538
Oklahoma City, OK 73157-2538
Contact Us