2003 Ark-La-Miss Division
Junior Olympic Qualifier and
Summer Nationals Team Entry Form
AGE ELIGIBILITY RULES FOR THE JUNIOR OLYMPICS 2004
U20: 1984-1990 or on the Cadet NRPS
U17: 1987-1990 or on the Y14 NRPS
Name: _____________________________ Date of Birth: ______________
Address: _______________________________________________________
City/State/Zip: __________________________________________________
Club: ________________________________________________
School: _____________________________Coach: _____________________
Email Address: _________________________________________
Male Female
Classifications: (example: E02) Epee: _____ Foil: _____ Sabre: _____
Events Entering:
Junior Olympic Qualifier
EPEE FOIL SABRE
U20 ___ M ___ W U20 M ___W U20 ___M ___W
U17 ___ M ___W U17 ___ M ___W U17 ___M ___W
Summer Nationals Qualifier (complete last sheet also)
TEAM EPEE TEAM FOIL TEAM SABRE
U19 ___M ___W U19 ___M ___W U19 ___M ___W
ENTRY FEES:
|
REGISTRATION FEE |
$10.00 |
|
EVENT FEE ___x $5.00 (events entered) |
$ |
|
TOTAL DUE |
$ |
Entries must be received by the division secretary by October 25 to avoid a late penalty. Entries received between October 26 and November 7 will be assessed a late fee of 1.5 times the entry total. Entries at the door will be assessed a late fee of double the entry fee total, NO EXCEPTIONS. Only the actual entry itself must be received by these dates. Payment is not due until check-in (at the tournament.)
Name: ____________________________DOB:_____________
WAIVER OF LIABILITY:
Upon entering this event, sponsored by the USFA and/or it's affiliates, I agree to abide by the rules of the USFA, as currently published. I understand and appreciate that participation in a sport carries a risk to me of serious injury, including permanent paralysis or death. I voluntarily and knowingly recognize, accept and assume this risk and release the USFA, their sponsors, event organizers and officials from any liability.
_______________________________ DATE: _____
SIGNATURE OF PARTICIPANT (PARENT/GUARDIAN IF UNDER 18)
CHECK-IN(STAFF USE ONLY):
USFA MEMBERSHIP (CHECKED NEW)
WAIVER SIGNED
FEES COLLECTED
2003 Ark-La-Miss Division
U19 Team Qualifier Entry Form
Club: ________________________________
Only one team per club may be entered. Entry fee is $20 per team.
Members of each club’s team MUST be a primary member of that fencing club.
Please fill out a separate entry form for each team and each event. Clubs need only pre-register that they are fielding a team. Team members need not be designated until tournament registration
Event: U19 Team ME MF MS WE WF WS
Fencer 1(Captain):
Name: ________________________________________
Date of Birth: __________________________________
Fencer 2
Name: ________________________________________
Date of Birth: __________________________________
Fencer 3
Name: ________________________________________
Date of Birth: __________________________________
Fencer 4
Name: ________________________________________
Date of Birth: __________________________________
If any of the above fencers did not compete in the individual competition, then a waiver of liability MUST accompany this entry form.
WAIVER CHECK:
Fencer 1
Fencer 2
Fencer 3
Fencer 4