Team Name:

Santa Clarita Pediatrics

Team Fee Paid:

Yes

Qualify for

LAST NAME

FIRST NAME

Method of Individual Registration

Minor Under 18yrs

Wrist band

Event T-shirt ($100)

Date Shirt was Picked up

Shirt Size

Free Lunch ($100)

Free Dinner ($100)

CHECKS/CASH

ON-LINE

GRAND TOTAL

Cervantes

Jessica

Member

Online

Yes

Yes

5/13/2010

YL

Yes

Yes

$    100.00

$            100.00

$                     -

$            100.00

Matallana

Astri

Member

Online

Yes

Yes

5/13/2010

YL

Yes

Yes

$    100.00

$            100.00

$                     -

$            100.00

Orona

Julie

Member

Online

Yes

Yes

5/13/2010

L

Yes

Yes

$    100.00

$            100.00

$              70.00

$            170.00

Perez

Andy

Member

Online

Yes

No

XXXL

No

No

$                     -

$                     -

Perez

Eloise

Member

Online

Yes

No

L

No

No

$                     -

$                     -

Tennison

Amanda

Member

Online

Yes

No

L

No

No

$                     -

$                     -

Tennison

Christina

Captain

Online

Yes

Yes

5/13/2010

2XL

Yes

Yes

$    100.00

$            100.00

$                     -

$            100.00

Trejo

Fatima

Member

Online

Yes

Yes

5/13/2010

S

Yes

Yes

$    100.00

$            100.00

$                     -

$            100.00

Vadapalli

Sunanda

Member

Online

Yes

No

M

No

No

$                     -

$                     -

West

Brianna

Member

Online

Yes

No

YM

No

No

$                     -

$                     -

Yen

Morris

Member

Online

Yes

No

M

No

No

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

$                     -

GENERAL DONATIONS

$        6.00

$    280.00

$    816.94

$    751.00

$         1,853.94

$            150.00

$         2,003.94

Registration Overpay

$                     -

$                     -

Corporate Sponsor

$                     -

$                     -

Day Of - Team Raffles

$    325.00

$    252.00

$            577.00

$            577.00

Day Of -Booth Sales

$                     -

$                     -

11

5

5

5

$        6.00

$    300.00

$    280.00

$ 1,016.94

$ 1,076.00

$    252.00

$             -

Total # of bands

Total # of shirts

Total # of lunch

Total # of dinner

11/18/2009

3/16/2010

4/20/2010

5/11/2010

Count of team members

11

Kick-off

capt meet

capt meet

capt meet

relay

relay

$         2,930.94

$            220.00

$         3,150.94

Entry # 1

Entry # 2

Entry # 3

Entry # 4

Entry # 5

Entry # 6

(Checks/Cash)

(On-Line Only)

Total to Date

Santa Clarita Pediatrics