The GatewayChallenge

                              THE GATEWAYCHALLENGE COURSE

                                                  REGISTRATION FORMS

PRINT THE FOLLOWING PAGE. COMPLETE AND RETURN TO THE GATEWAY.

DATE:_____________________________

NAME:__________________________________________________

BIRTHDATE:_____________________________________________

OCCUPATION:___________________________________________

TELEPHONE:_____________________________

E-MAIL:_________________________________

ADDRESS:___________________________________________________________________________

EMERGENCY CONTACT NO.:_____________________________________________

EMERGENCY CONTACT NAME:____________________________________________

REGISTRATION FEE IS 15.00 PER PERSON

CHECKS ARE TO BE MADE TO THE GATEWAY CHALLENGE

MAILED TO 1468 SW MAIN BLVD STE. 105-10LAKE CITY FL 32025

RETURN A COPY OF THE COMPLETED REGISTRATION FORM WITH THE CHECK

 REGISTRATIONS MUST BE RECEIVED BY AUGUST 1 2010