Individual Entry ($70)

Name __________________________________________________________

Email Address_________________________________________________________

Phone Number________________________________________________________

Team Entry (Check One) ($350)

______Boys Team             _____ Girls Team     _____Co-Ed Team

Team Name___________________________________________________________

Captain's Name ___________________________________________________________

Email address of Capt._______________________________________________________

Member # 2_______________________________________________________________

Member # 3_________________________________________________________________

Member # 4__________________________________________________________________

Member # 5_________________________________________________________________

Member #6 __________________________________________________________________

Member #7 __________________________________________________________________

Mail entry form and Check or Money Order to

Illinois Prep Top Times

2324 N. Kenneth Ave.

Chicago, IL 60639