ChiSlam Intermediate

Table Tennis Open

The non-sanction tournament: Non USATT member required: Tournament Date: Feb21 2016

Tournament Director: Ardy S.Taveerasert Referee: Ardy S. Taveerasert

Chi Slam Spin Attack Table Tennis Club Contact Person: 312-287-9852 Ardy

Tournament Location: ChiSlam TTC Club /Mr. Ping Pong

1647 W. Chicago Ave. Chicago IL60622

Email: Tournament Rules: USATT Rules

Website: Equipments : 5 Killerspin Tables / White 3 Star Balls

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ChiSlam Single Tournament Schedule Fees Prize # 1 2 Semi

1. ChiSlam Intermediate Open Sun Feb 212016 Start: 11am-3pm $20.00 Trophy T T

Under USATT 1600 > Woman ,Senior & Kids Under 18 years welcome for this tournament.

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Full Name ______Phone______

Address______Email______

Sex: Male or Female Age:_____USATT Member#______USATT Rating______Expired______

Chi-Slam Member: Yes or No. If No, Your club or sponsor’s name______

Please circle the event # 1 Total Event Fees $______

Balance Total $______

Pay in full by Check or Cash By Date Fri Feb 192016 *No Credit or Refund

Make Check payable to A&S Chicago Inc. Mail to Address: 1647 W. Chicago Ave. Chicago IL 60622 Email: or send directly to the Chi-Slam Table Tennis Club

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*All fees must be paid with your entry. Entry deadline Sat Feb 21 2016 6:00pm

* Call 312-287-9852 > Ardy, for last minute entry.

*All Players must register at control desk half an hour before the competition.

* Default Time, is start time.

* The event official has the right to modify or change the prize & cancel events if not enough entries.

* If the event is cancelled for any reason > ChiSlam TTC will refund the entry fee.

*********************************************************************************** Please Note: All participants must read and sign The Waiver & Release Form on the back of this page

“ChiSlam Spin Attack Table Tennis Club/ Tournament Assumption, Waiver and Release Form”

I hear by assume all risk and responsibility for my participation in this tournament, and I release any and all sponsors, Chi-Slam TTC, A&S Chicago Inc, U Table Tennis.com, Mr. Flower &Mr.Ping Pong,Directors, Referee and any volunteers from any claims, action or demands for any loss, damage, personal injury or death. I understand and will abide by all Chi-Slam TTC rules and regulations and the decisions of the referee and director.

I am at least 18 years old and I enter this agreement knowingly and voluntarily.

Print First name ______Last name______

Signature______Date______

Parent/Guardian if player is under 18 Year Old /Name______

Signature______Date______

*Check our table tennis products website: table tennis for U