1996 HACKY SACK WORLD FOOTBAG CHAMPIONSHIPS
Montreal August 5-11
REGISTRATION FORM
(Please Type or Print Clearly)
Name: ___________________________________________ Date: _______________
Address: ________________________________________ Phone: ______________
City: _________________ State/Province: _____________ Zip: ___________
Country: ______________ T-shirt Size: Small [ ] Med [ ] Large [ ] X-Lg [ ]
Address Change? N [ ] Y [ ] Gender: F [ ] M [ ] Birthdate: ___/___/___
WFA Member? N [ ] Y [ ] Member# ___________________
Player Status:
Amateur [ ]
Professional [ ]
Club Affiliation: ________________________________
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 US x $3 US
------- -------
Total Both Open
& Int. Event Costs [_____] + [_____] = [______]
+
Tournament Entry Fee (Pro - $60 US or Am - $25 US) [______]
Late Registration Fee +
(postmarked after 07/18/96 - add $10 US)
______]
(All players must be pre-registered)
------------
Grand Total [______]US
***For the Canadian participants who would like to pay in
Canadian funds just multiply the grand total by 1.40 [______]CDN
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 1996 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 World Footbag Association (WFA) and the
Association Quebecoise de Aqi-Footbag (AQAF). I understand and hereby
authorize the WFA and the AQAF 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 the WFA, AQAF, Mattel
Sports, LaRonde, Ville de Montreal 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 MONEY ORDER only payable to:
Association Quebecoise de Aqi-Footbag
c/o Yves Archambault
410 St-Joseph street
Montreal, Qc
H2J-1J5
Canada
For more info.: Yves Archambault 514-845-2194
Martin Cote 514-875-6723
E-mail: worlds@footbag.org
Web: http://www.footbag.org/worlds/