REGISTRATION FORM

2013 Yukon Mixed Doubles National Qualifier

Registration Fees:

All teams entering the Yukon Curling Championships must:

  1. Complete the attached Team Registration Form in full.
  2. Team members must also sign and date the attached Player Affidavit Form.

Registration fees must be received by the Yukon Curling Association office on or before the registration deadline.

Registration fees for 2013 Event:

$100 per Mixed Doubles Team

All cheques are to be made payable to the Yukon Curling Association.

Competitor Fees:

Competitor Fee are not applicable for the Mixed Doubles Event.

Registration Deadline:

The Registration Deadline for this event will is 5:00pm on January 29th, 2013. This is the deadline to have completed and signed registration forms, as well as registration fees submitted to the YCA.

Age Requirements:

There are no age requirements or restrictions for this event.

Length of Competition:

The length of the competition will be declared immediately after the entry deadline, once the final number of teams entered is determined. The event initially is scheduled to take place from Friday February 1st, until Sunday February 3rd, 2013. In the event that a third day of draws is not required, based on the number of teams registered, all games will be held on Saturday and Sunday, February 2nd and 3rd.

Accommodation, Transportation and Meals:

Individuals are responsible for arranging their own accommodation, transportation and meals for any championship.

Address:

Completed registration packages can be mailed, dropped off at the YCA Office, or at the front desk of Sport Yukon. Registration packages can be sent via e-mail, but must include scanned or faxed copies of the player affidavit and participation waiver, and original signed copies must be provided prior to the start of the event.

If you wish to arrange to pay registration fees via credit card, contact that YCA at .

Yukon Curling Association

4061 - 4th Avenue

Whitehorse, Yukon

Y1A 1H1

Tel: 867-668-7121

Fax:867-667-4237

E-Mail:

Confirmation:

Teams will be provided a copy of the schedule and draw for their competition in a timely manner following the registration deadline of their respective championship events.

TEAM REGISTRATION FORM

Name of Competition: ______

Dates of Competition: ______Location: ______

Player 1: First Name:______Last Name______

Address: ______Postal Code______

Phone (Work):______Phone (Home): ______

Fax: ______E-Mail: ______

Date of Birth:______

Player 2: First Name:______Last Name______

Address: ______Postal Code______

Phone (Work):______Phone (Home): ______

Fax: ______E-Mail: ______

Date of Birth:______

Date of Birth:______

Coach: First Name:______Last Name______

Address: ______Postal Code______

Phone (Work):______Phone (Home): ______

Fax: ______E-Mail: ______

Coaching Certification Level:______

Team Contact: ______

Phone (home, work, cell #s): ______

Email: ______

PLAYER AFFIDAVIT AND PARTICIPANT WAIVER

I, the undersigned, as a participant in sanctioned Yukon Curling Association and Canadian Curling Association events, understand that there are expectations of me as to my conduct and behaviour at these competitions. I agree to abide by the rules and requirements as outlined in the Yukon Curling Association’s Policy and Procedures Manual and the Yukon Curling Championships Team Registration Package. Should I fail to follow these rules, I realize I may be removed from these competitions and sent home at my own expense and could be subject to further disciplinary action after the competition. Other forms of disciplinary action could also be taken during the competition depending on the seriousness of the infraction. … AND

I hereby signify my commitment, if successful, to compete at the Yukon/Northwest Territories Curling Championships, Canadian Curling Championships, 2012 AWG and where applicable, the World Championships. Failure to comply with this rule will lead to a minimum two-year suspension from future Yukon Curling Association and Canadian Curling Association Competitions:

Name: ______(please print) Date: ______

Signature: ______Witness: ______

Under 18: ______(Signature of Parent)

Name: ______(please print) Date: ______

Signature: ______Witness: ______

Under 18: ______(Signature of Parent)

Name: ______(please print) Date: ______

Signature: ______Witness: ______

Under 18: ______(Signature of Parent)

NOTE: All team members and coaches are required to complete and sign the above affidavit.

TRAVEL CLAIM FORM

Yukon Junior Men’s and Junior Women’s Curling Championship

Yukon Scotties Tournament of Hearts Women's Championship

Teams will be reimbursed at a rate of $0.16 per kilometer based on a minimum of four team members per vehicle.

Team Name: ______

Number of team members in vehicle: ______

Community/Location of Team: ______

Name of individual that cheque will be issued to: ______

(please print)

Mailing Address:

______

Postal Code: ______Phone (Daytime): ______

FOR INTERNAL USE ONLY

Date Received: ______Received By: ______

Amount Paid Out: ______

NOTE: The travel claim must be completed and submitted to the Yukon Curling Association within one calendar month of completion of relevant competition.

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2013 Yukon Mixed Doubles – Registration PackageJanuary 2013