American Canoe Association WWOC Slalom Nationals
1999 ACA WWOC Slalom Nationals Entry Form
Name:
_____________________________________ Sex: ____ Date of Birth:
___________
Address: _____________________________________________ ACA#
_________________
City: ________________________ State: __________________ Zip:
___________________
Phone: ______________________ e-mail:
_________________________________________
Fees:
Pre-registration (postmarked by June 21) $25 per person (for one
race class); each additional class is $10. Late Registration fee
$10. If you are not an ACA member, add $5 for event membership to
cover insurance. One Race T-shirt is included per entry packet
($10 for each additional T-shirt). Additional $7 for BarBQ dinner
ticket for Saturday's Race Dinner..
In the lists below, mark the classes you wish to enter (maximum 5
classes).
Competitors may race in both REC and RAC classes, but not for the
same class.
| Saturday July 10 - Slalom | Sunday July 11 - Slalom |
| Class | RAC | REC | Partner's Name | Class | RAC | REC | Partner's Name |
| OC-2 Cadet/Senior | ____ | n/a | ________________ | OC-2 Premier | ____ | ____ | ________________ |
| OC-2 Mixed | ____ | ____ | ________________ | OC-2 Masters | ____ | ____ | ________________ |
| OC-2 Junior | ____ | n/a | ________________ | OC-1 Premier Short | ____ | n/a | |
| OC-1 Master | n/a | ____ | OC-1 Junior | ____ | n/a | ||
| OC-1 Premier | n/a | ____ | OC-1 Masters Short | ____ | n/a | ||
| OC-2 Women | ____ | n/a | ________________ | OC-1 Women | ____ | ____ | |
| OC-1 Master Med | ____ | n/a | OC-1 Premier Med. | ____ | n/a |
( the Slalom portion of the
Combined event will be held Sat and Sun, the race order decided
later)
Monday July 11 Combined (Downriver Sprint
portion of the Combined event)
| Class | RAC | REC | Partner's Name | Make checks payable to: | |
| OC-1 Women | ____ | ____ | Rocky Mt. Canoe Club-Nationals | ||
| OC-2 Mixed | ____ | ____ | _____________________________ | Send payment & completed forms to: | |
| OC-1 Premier | ____ | ____ | Jill Stecker, '99 Nationals | ||
| OC-2 Premier | ____ | ____ | _____________________________ | 279 Forrest Lane |
| Basic registration fee ($25) | $ ________ | Boulder, CO. 80302 | |
| No. of additional classes you will enter____x $10 | $ ________ | ||
| ACA event membership ($5) | $ ________ | ||
| Late registration fee ($10 if after Jun 21th) | $ ________ | ||
| No. of $7 tickets for the BBQ ____. | $ ________ | ||
| No. of extra T-shirts ($10) S___M___L___XL___. | $ ________ | Total amount enclosed $________ | |
| Your T-Shirt Size _______ |
AMERICAN
CANOE ASSOCIATION
WAIVER & RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in
the American Canoe Association, Inc. athletic/sports programs and
related events and activities, the undersigned:
1. Agree that prior to participating, they each will inspect the
facilities and equipment to be used, and if they believe anything
is unsafe, they will immediately advise their coach or supervisor
of such condition(s) and refuse to participate.
2. Acknowledge and fully understand that each participant will be
engaging in activities that involve risk of serious injury,
including permanent disability and death, and severs social and
economic losses which might result not only from their own
actions, inactions or negligence but the actions, inactions or
negligence of others, the rules of play, or the condition of the
premises or of any equipment used. Further, that there may be
other risks not known to us or not reasonably foreseeable at this
time.
3. Assume all the foregoing risks and accept personal
responsibility for damages following such injury, permanent
disability or death.
4. Release, waive, discharge and covenant not to sue American
Canoe Association, Inc., its affiliated clubs, their respective
administrators, directors, agents, coaches, and other employees
of the organization, other participants, sponsoring agencies,
sponsors, advertisers, and if applicable, owners and leasers of
premises used to conduct the event, all of which are hereinafter
referred to as "releasees," from any and all liability
to each of the undersigned, his or her heirs and next of kin for
any and all claims, demands, losses or damages on account of
injury, including death or damage to property, caused or alleged
to be caused in whole or part by the negligence of the releasees
or otherwise.
THE UNDERSIGNED HAVE READ THE ABOVE WAIVER AND RELEASE,
UNDERSTAND THAT THEY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING
IT, AND SIGN IT VOLUNTARILY.
| _______________________________ | ____________ | ___________ | __________ |
| signature of participant | ACA memb. # | date of signing | date of birth |
| _______________________________ | __________________________________ |
| printed name of participant | address, city, state, zip |
club or
organization:___________________________________________________________
When the participant is a MINOR (under 18 yrs.): Age of
participant:_______
| ___________________________ | ___________________________ | ___________ |
| signature of parent or guardian | printed name of parent or guardian | relationship |
Be sure to complete and return both forms
For additional entry
information phone Bob or Jill Stecker (303) 444-3979, 8am-6pm
MST,
or email bobjillc2@cwix.com