(Required fields are bold)

Email Address *
First Name
Last Name
High School
City
State
Zip
Graduation Year (Last 2 Digits)
Date of Birth	Month Day Year ( mm / dd / yyyy )
Phone
2011 CAMPER	No Yes
2011 Club Simpson Elite	No Yes
2011 Intensive Camper	No Yes
2011 Youth Camp #2	No Yes
2011 Youth Camper	No Yes
2011 ACE	NO YES
2011 HS FALL CAMPER	NOYES
2011-12 SGT	Junior High HS Lightweight Middle-Upperweight Youth Intermediate None
2012 Club Simpson Elite	No Yes
2012 Camper	NoYes
2012 Intensive Camper	No Yes
2012 Youth Camper	No Yes
2012 ASA	NoneACEACNBoth
2012 Fall Camper	NoHSYouth
2012-13 SGT	Junior High HS Lightweight Youth HS Middle-Upperweight None
2013 JH State	No Yes
2013 Club Simpson Elite	No Yes
Elite Club Group	Early Late None
USA Division	None Bantam Intermediate Novice Schoolboy Cadet Junior
Northridge Area	Northridge Area  Northridge Area
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