Registration Form - Usapa Pickleball

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PICKLEBALL TOURNAMENT MAIL-IN REGISTRATION FORM
2
ANNUAL ISLAND REC CENTER PICKLEBALL TOURNAMENT NOVEMBER 7-8, 2014
ND
Name:
Age as of 12/31/2014:
Gender: M / F
Tel:
Address:
City:
State:
ZIP Code:
Email:
Please put an “X” by events you are entering and your partner’s name below. Your partner must also register and pay
th
an event fee. Registration closes Oct 29
, but may close earlier if the number of registrants gets close to our facility
capacity.
Men’s Doubles:
( )
Partner’s Name: ______________________________________________
Women’s Doubles:
( )
Partner’s Name: ______________________________________________
Mixed Doubles: ( )
Partner’s Name: ______________________________________________
First Event Fee: ( ) $25.00 Second Event Fee: ( ) $10.00
Total: ________
Tournament Tee Size
S (
) M (
) L (
) XL (
) XXL (
)
Extra Tees @ $10.00/each S (
) M (
) L (
) XL (
) XXL (
)
Total: ________
Grand Total: ________
Make check payable to: Island Rec Center Pickleball Tournament
GENERAL RELEASE AND WAIVER:
In consideration of the acceptance of my registration for the Tournament, I hereby for myself, my heirs, executors, administrators, or any others
who may claim on my behalf, covenant not to sue, and hereby waive, release and discharge the Town of Hilton Head and HH Island Rec Center,
and anyone acting for or on Town of Hilton Head or HH Island Rec Center’s behalf, from any and all claims of liability for injury, loss, or damage
of any kind or nature, arising out of or sustained in the course of my participation in the Tournament. This Release and Waiver applies to all
claims, foreseen or unforeseen, including negligence and breach of statutory or other duty of care (including that owed under the Occupier’s
Liability Act).
___________________________________________
____________________________________________
____________________________
Players’ Name
Player’s Signature
Date
Please return completed forms to: Bob Rozek, Island Rec Center, PO Box 22593, Hilton Head, SC 29925
W 843-681-7273 C 843-683-7204
***EVENT FEES BENEFIT ISLAND REC CENTER AND ARE TAX DEDUCTIBLE***

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