2014 NJHA Convention Registration


Fill out the electronic form below and click Submit, or click here to download a PDF of the form that can be printed on WHITE paper and mailed to: Carole Carney 15 Railroad Ave., Homer City, PA 15748.

Must be submitted by September 15.

If submitting online, click here for fee listing and additional information.




State:


Name:    
Last  First (for name tag) 


Address:

Email Address:

Home Phone Number:

Parent Work Phone Number:

Youth Cell Phone Number:


Please indicate name of coach.

Date of birth (must be 15 but not over 22 on 12/31/14)

Handicap or special dietary needs
(Such as: vegetable, salt, gluten free, lactose, etc.)



By submitting this form, I hereby grant NJHA the right to publish and copyright my image (including audio, moving image or photography) for educational programs, websites, and promotion of NJHA programs.


IMPORTANT NOTICE:
YOUTH AGE 15 AND UNDER MUST BE ACCOMPANIED BY A PARENT OR GUARDIAN.


OPTIONAL TOUR ON MONDAY MORNING OCTOBER 13TH.
We will leave hotel at 5:00 A. M. to the Keeneland Racetrack to watch the thoroughbred race horses in their morning workout. Return to hotel at 8:00 A. M. for breakfast. If you would like to go on this tour, please check here.



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