2004 Wavesailing Nationals Entry form
AUSTRALIAN WAVESAILING TITLES 2004
ROBE ISLAND, SOUTH AUSTRALIA. JAN 31st - 6th FEB 2003.
ENTRY FORM (To be submitted by December 30th)
NAME......................................................................... SAIL NUMBER (if any).............................................
ADDRESS............................................................................................................................................................................................................................................................................ POST CODE......................
TEL No.............
....................................... MOBILE No..........................
.
E MAIL....................................................... DATE OF BIRTH
NSWWSA MEMBERSHIP ........................ (Temporary Membership Available on the day)
CLUB MEMBERSHIP
(For insurance purposes)
Please enter me for the AUSTRALIAN WAVESAILING TITLES 2004.
I enclose a cheque made payable to NSWWSA for $100 ($120 if paid after December 30th 2003)
sign...............
..
Please enter me for the AUSTRALIAN WAVESAILING TITLES 2003 INTERNATIONALS FLEET.
I enclose a cheque made payable to NSWWSA for $100 ($120 if paid after December 30th 2003)
sign...............
..
Please enter me for the AUSTRALIAN WAVESAILING TITLES 2004 MASTERS FLEET (OVER 35).
I enclose a cheque made payable to to NSWWSA for $100 ($120 if paid after December 30th 2003)
sign...............
.
Please enter me for the AUSTRALIAN WAVESAILING TITLES 2004 JUNIOR FLEET (UNDER 18).
I enclose a cheque made payable to NSWWSA for $50 ($60 if paid after December 30th 2003)
sign...............
..
Please enter me for the AUSTRALIAN WAVESAILING TITLES 2004 LADIES FLEET.
I enclose a cheque made payable to NSWWSA for $50 ($60 if paid after December 30th 2003)
sign...............
..
Waiver Release and Indemnification
1. I agree to partake in the Australian Wavesailing Titles of my own free will and join the NSWWSA with the full understanding of the inherent dangers and risks associated with the sport of Wavesailing.
2. In signing this form in the appropriate sections at the appropriate times, I indemnify the NSWWSA and the committee members or anyone connected with the NSWWSA from any responsibility for any damage incurred to any property, injury to any person, or any legal action arising from the use of associated equipment, socially or at any organised event, be it on land or in water.
3. I realize that I have sole responsibility for my safety
4. I agree to abide by the decisions and instructions set down by the NSWWSA committee as well as any rules set down by the event hosts and organisers
5. I waive and release any claims that I may have against organisers, sponsors, members, committee members and volunteers of the NSWWSA, including any and all claims for damage arising out of my participation, or of that of my sailboard in these events.
6. I understand that as a competitor at this event I am covered for third party public liability insurance only
7. If under 18 years of age, a parent or guardian must sign as well.
Signed...................................... Date.........................
Please download and save this form. Fill in appropriate sections and send with payment to:
Event Manager
25A Carrington Ave
Cromer NSW 2099
Entries will be taken up to the day before the start of competition.
If emailing this form please send form plus CC details with expiry date to: a_constable@hotmail.com or info@eastcoastboardriders.com.au
Entry includes spot prizes draw, event t-shirt, entry to welcoming and presention dinners.
For further enquiries please contact the Event Manager or (02)9905-7664 or (02) 9984-0654.
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