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CONTACT INFORMATION CONTAcT Name: * Birth date: * Cell Phone: * Gym/Studio/School Phone: * Home Phone: * Email: *   Your status within the program: Gym/Studio Owner Coach All Star Director Parent Registration Administrator Other Booster President     Other:

PROGRAM INFORMATION Organization Name: * Physical Address: * City: * State: Zip: Outside US / Canada Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   * Gym/Team Website: Team Colors:   # of Cheer Teams in Program # of Cheer Athletes in Program # of Dance Teams in Program # of Dance Athletes in Program     Type of Program: (choose all that apply) All Star Cheer All Star Dance School Cheer School Dance College Cheer College Dance Rec/Youth League Cheer Rec/Youth League Dance Dance Studio   Have you ever attended a Coastal event?: Yes No If you answered yes... What event and year?

I WOULD LIKE MORE INFORMATION ON... (check all that apply)   Cheerleading Events Choreography Multiple Event Discounts Dance Events The U.S. Finals The JAM Rewards National Competitions JAMcamps JAMwear Merchandise Coastal Events UCE     Private Camps Individual Skills Camps

WHICH OF THE FOLLOWING REPRESENTS YOUR TEAM/PROGRAM? (check all that apply)   Cheer Dance Both

WHICH Coastal EVENTS ARE YOU INTERESTED IN? (check all that apply) JAMfest Lite Series TBD, AR August JAMfest Mega-JAM Series Louisville, KY October 6-7, 2012 JAMfest Mega-JAM Series Columbus, OH October 13, 2012 JAMfest Mega-JAM Series Peoria, IL October 20, 2012 JAMfest Mega-JAM Series Evansville, IN October 27, 2012 JAMfest Mega-JAM Series Dekalb, IL October 28, 2012 JAMfest Mega-JAM Series Topeka, KS November 3, 2012 JAMfest Mega-JAM Series Pittsburgh, PA November 3 or 10, 2012 JAMfest Mega-JAM Series Detroit, MI November 10, 2012 JAMfest Mega-JAM Series Nashville, TN November 10, 2012 JAMfest Mega-JAM Series Branson, MO November 17, 2012 JAMfest Mega-JAM Series Atlanta, GA November 17, 2012 JAMfest Mega-JAM Series Indianapolis, IN November 17, 2012 JAMfest Mega-JAM Series Upper Marlboro, MD December 1, 2012 JAMfest Mega-JAM Series Cleveland, OH December 2, 2012 JAMfest Mega-JAM Series Hot Springs, AR December 8, 2012 JAMfest Mega-JAM Series Worcester, MA December 8, 2012 JAMfest Mega-JAM Series Winston-Salem, NC December 9, 2012 JAMfest Mega-JAM Series Dayton, OH December 15, 2012 JAMfest Lite Series Huntsville, AL December 16, 2012 JAMfest Mega-JAM Series Pasadena, CA January 13, 2013 JAMfest Mega-JAM Series Denver, CO January 13, 2013 JAMfest Cheer Super Nationals Indianapolis, IN January 18-20, 2013 JAMfest Mega-JAM Series Baton Rouge, LA January 26, 2013 JAMfest Mega-JAM Series Tulsa, OK January 26, 2013 JAMfest JAM-Bash Series Jacksonville, FL January 27, 2013 JAMfest Mega-JAM Series Birmingham, AL February 2, 2013 JAMfest Mega-JAM Series Dayton, OH February 2, 2013 JAMfest JAM-Bash Series Nashville, TN February 2, 2013 JAMfest Mega-JAM Series Omaha, NE February 2, 2013 JAMfest JAM-Bash Series Shreveport, LA February 9, 2013 JAMfest Lite Series Charleston, WV February 10, 2013 JAMfest Mega-JAM Series Norfolk, VA February 10, 2013 JAMfest Dance Super Nationals Cincinnati, OH February 15-17, 2013 JAMfest JAM-Bash Series St. Charles, MO February 16, 2013 JAMfest Nationals Series Kansas City, MO February 16-17, 2013 JAMfest Nationals Series Mobile, AL February 16-17, 2013 JAMfest Lite Series Southaven, MS February 23, 2013 JAMfest JAM-Bash Series Chicago, IL March 3, 2013 JAMfest Nationals Series Oklahoma City, OK March 2-3, 2013 JAMfest JAM-Bash Series Biloxi, MS March 9, 2013 JAMfest Mega-JAM Series Syracuse, NY March 9, 2013 JAMfest Nationals Series Long Beach, CA March 16-17, 2013 JAMfest Mega-JAM Series Philadelphia, PA March 17, 2013 JAMfest Nationals Series Louisville, KY March 23-24, 2013 JAMfest Nationals Series Pittsburgh, PA March 23-24, 2013 JAMfest National Series Gatlinburg, TN April 6-7, 2013 JAMfest Nationals Series Hot Springs, AR April 6-7, 2013 JAMfest JAM-Bash Series Orlando, FL April 6, 2013 JAMfest Nationals Series Lowell, MA April 13-14, 2013 JAMfest Nationals Series Las Vegas, NV April 13-14, 2013 JAMfest Nationals Series Richmond, VA April 20-21, 2013 JAMfest Six Flags Springfield, MA April 27-28, 2013

WHO IS YOUR JAMCARE REP? Jason Matthews Cell: 502.415.1016 JasonM@thejambrands.com Dawnn Doychak Cell: 502.266.6526 Dawnn@thejambrands.com Chad Lemon Cell: 502.338.0212 Chad@thejambrands.com Griffin Myers Cell: 606.422.3861 Griffin@thejambrands.com Paul Van Gilder Cell: 502.593.5395 Paul@thejambrands.com Tara Patton Cell: 502.551.2260 Tara@thejambrands.com Brandi Sims Cell: 703.314.2660 Brandi@thejambrands.com Dana Metzler Cell: 502.550.5034 Dana@thejambrands.com Hayley Schumaker-Reyes Cell: 949.292.7727 hayley@thejambrands.com Click here to view theJAMcare Rep map **The JAMcare Rep should be filled in automatically. If not, then make sure your state is selected above.

HOW DID YOU FIND THIS SITE? (check all that apply)   Coastal Brochure Inside Cheerleader Magazine Word-of-Mouth American Cheerleader Magazine Dance Spirit Magazine Search Engine Cheer Biz Magazine The Cheerleader Magazine News Media

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