Interstate Clearance Form

By submitting this application, I agree that the members listed are endorsed to attend this activity by my club and further that they adhere to all necessary PDB, SLSQ and SLSA policies to be able to participate in the listed activity. I further acknowledge that the facts set forth in it are true and complete.

I understand that, any false statements, omissions, or other misrepresentations made by me on this application may result in discipline action.

• This document must be submitted seven (7) days prior to the event taking place.
• All members listed must be registered, proficient (if competing) and hold a blue card (if over 18)
• All other members must be registered and hold a blue card (if over 18)
• All Chaperones and Team Managers must be listed, be registered  and hold Blue Cards
• If this a non competitive trip (e.g. youth trip) a full itinerary and list of activities must be attached