REGISTRATION FORM

Infront Big Board Bounty
Wanda Beach 6th October 2012

HOW TO ENTER:Bulk Club entries are submitted on-line using the Sydney Branch “Carnival Manager System” prior to 3 October 2012 at after 28th September 2012, entries are deemed Late - individuals can enter via 28 September and 3 October; after 3 October and up to 6 October, entries are manual via download and complete this form (and refer to the “Important Race Information” below)

SURNAME Sex: M / F Age DOB. dd / mm / yy

GIVEN NAMES SLSA proficiency number SLSA Club

STREET ADDRESS STD Phone

SUBURB / TOWN Postcode EMAIL ADDRESS

Age Group - mark “”

U9 / U10 / U11 / U12 / U13 / U14 / U15 / U17 / Open

Payment method - mark “”:Cheques to be made payable to WANDA JAG.

Cash (on race day only) / Cheque / Credit card / Total enclosed $
Credit card details / Visa / Mastercard /
Signature / Expiry

If under 18 years of age, this section must be signed by your Parent or Guardian.

I certify that I am the Parent / Guardian of who is years of age

and has my consent to participate in the

above event. Child’s name

SIGNATURE: (Parent / Guardian)

DECLARATION BY PARENT: In consideration of this entry being accepted I hereby indemnify all persons, corporations

and bodies involved or otherwise engaged in promoting the above event and the servants, agents, representatives

and officers of any of them, from any claim, right, cause of action the said child or any person may have arising out of loss of life or injury, damage or loss of any description airing from any child entering or participating in the said event.

REPORT: Saturday 6 October 2012 at Wanda S.L.S.C, Wanda Beach. Late registration on 6 October 6.00am to 7.00am. U9 – U17 marshall7.30am for an 8.00am start; Opens marshall10.30am for an 11.00am start.

ENTRY FEES:

  • $35 per single entrant; entered via Sydney Branch “Carnival Manager System” by 23September 2012
  • Late Entry fee: $45 per entrant – between 23 September 2012 and 3 October via Sydney Branch “Carnival Manager System” or via manual entry from 3 October 2012 to 7.00am on 6 October 2012.
  • Entry fees are per Age Group event i.e. where eligible, participants wishing to compete in their respective Age Group and Opens must pay entry fees for both Events.
  • Entry fees must be paid to or have been received by Wanda JAG prior to the commencement of the first event – no payment, no start.Enter through respective S.L.S.A Club via the Sydney Branch “Carnival Manager System” at 24 September 2012 as late entries apply after 23 September 2012 .

OTHER:

  • All participants MUST have attained the relevant S.L.S.A proficiency level for the respective age group entered by 6 October 2012 and have an S.L.S.A proficiency number available for inclusion with their registration by 6 October 2012. Entrants CANNOT participate without same.

HON. ORGANISER: Infront Big Board Bounty Event Committee.