1995 WORLD FOOTBAG CHAMPIONSHIPS REGISTRATION FORM (Please Type or Print Clearly) Name: ___________________________________________ Date: _______________ Address: ________________________________________ Phone: ______________ City: _________________ State/Province: _____________ Zip: ___________ Country: __________________ T-shirt Size: Med [ ] Large [ ] X-Large [ ] Address Change? N [ ] Y [ ] Gender: F [ ] M [ ] Birthdate: ___/___/___ Player Status: Club Affiliation: ________________________________ Amateur [ ] Professional [ ] Have you ever competed at Worlds? N [ ] Y [ ] ************************* Event Categories ***************************** Open Women's Open Intermediate Partner Net Events: Singles [ ] [ ] Men's [ ] Women's [ ] Doubles [ ] [ ] [ ] _______________ Mixed Doubles [ ] _______________ Freestyle Events: Singles [ ] [ ] [ ] Team (of 2) [ ] [ ] _______________ Mixed Team [ ] (Demo event - no prize money) _______________ Preferred Judging Assignment - 1st choice ________ 2nd choice ________ (i.e.: X-Body/Body/Dexterity/Delay/Unusual/Presentation/Team/Adds/Contacts) Other Events: Golf [ ] [ ] [ ] Singles 5-Min. Personal Speed Consecs [ ] [ ] Best ______ Doubles Distance One-Pass Consecs [ ] [ ] _______________ _______________ _________ Enter # of Open Enter # of Int. Events Here ----> [_____] [_____] <-- Events Here x $5 x $3 ------- ------- Total Both Open & Int. Event Costs [_____] + [_____] = [______] + Tournament Entry Fee (Pro - $60 or Am - $20) [______] Late Registration Fee + (postmarked after 7/9/95 intl; 7/16/94 USA - add $10) [______] + # of Jimmy C. Nets you would like to buy [___] x $70 [______] ------------ Discount for Pros Bringing New Players: (All players must be pre-registered) Subtotal [______] # of Players [_____] ($25 for 1st player and - $10 for additional players) [______] Names _____________ ------------ _____________ Grand Total [______] If you are a scholarship winner, please indicate which approved tournament awarded you this scholarship. You must meet the pre- registration deadline to receive your scholarship. Scholarship awarded by: ________________________________________ *********************************************************************** Waiver For Participation I, ______________________, hereby wish to enter the 1995 World Footbag Championships at its set and agreed upon entry fee. I understand that this entitles me to participate in all events entirely at my own risk and cost. I also vow to conduct myself in such a manner that is within the guidelines set forth by the Bay Area Footbag Foundation, Inc. (BAFF). I understand and hereby authorize BAFF to use any and all film and video tape taken of me during this event, to be used for any purpose. In consideration of your accepting my (my child's) entry, I hereby, for myself (my child), my heirs, executors and administrators, waive and release any and all rights and claims for damages I (my child) may have against BAFF, WFA, Mattel Sports, The City of Menlo Park, and their representatives, successors and, assigns for any and all injuries suffered by myself (my child) at any activity sponsored by these groups. __________________________ ________________________________ Signature Guardian or Parent (if under 18 years old) Mail registration form with check or money order payable to: Bay Area Footbag Foundation, Inc. 647 Fallon Ave., Santa Clara, CA 95050 * (408) 247-9688