SOUTH COAST Kneeboard Classic October 11th & 12th 2014 NAME __________________________________________ D.O.B. __/__/____ ADDRESS ___________________________________________________________________ STATE ______ POSTCODE ________ Email __________________________________ Tel (____) _____________________ Mobile _____________________________________ ALL ENTRANTS MUST BE CURRENT FINANCIAL MEMBERS OF SURFING AUSTRALIA SURFING AUSTRALIA MEMBERSHIP NUMBER__________ Membership state __________ CONTEST IS 5 STAR RATED. MAXIMUM OF 64 ENTRIES ALL ENTRANTS COMPETE IN THE OPEN DIVISION Competitors meeting Friday 10th October at the Kiama Leagues Club 7.30 pm ADDITIONAL DIVISIONS Cadets ____ (under 16 at 1/1/14) Please tick Juniors____under 18 at 1/1/14 Womens ____ (all ages) ENTRY FEE $90 Cadets, Juniors, and Women $30 SEND ENTRIES TO : South Coast Kneeboard Classic. 6 Francis Road Flinders NSW 2529. ENTRIES CLOSE FRIDAY 3rd OCTOBER Australia Post Money Order or Direct Payment into Bendigo Bank account No personal cheques. Please Tick if using Direct Payment. _______ EFT DIRECT PAYMENTS : South Coast Kneeboard Classic : BSB 633 000 Account No. 152675864 Amount $_________ Date Paid ___/___/_____ Please use your name as a reference on the deposit YOU MUST STILL POST AN ENTRY FORM. In applying to compete in the South Coast Kneeboard Classic 2014 (“the Event”): I ACKNOWLEDGE that there are inherent dangers associated with the sport of surfing and my participation in the Event and that serious accidents can happen which may result in me being injured. To the full extent permitted by law, I agree to ABSOLVE AND INDEMNIFY Kneeboard Surf Australia INC ("KSA"), Surfing Australia (“SA”) and its affiliated State Branches (“SB”) and sponsors and their subsidiaries, directors officers and employees from and against any and all liability for injury, loss or damage however caused arising from my participation in the Event. I RELEASE AND INDEMNIFY AND WILL KEEP INDEMNIFIED KSA, SA, SB and sponsors and their subsidiaries, directors, officers and employees from all claims arising from my participation in the Event. I CONSENT to KSA, SA, SB and sponsors and their subsidiaries collecting and using my personal information for the purpose of administering and promoting the Event. I agree that KSA, SA, SB and sponsors and their subsidiaries may use images of my participation in the Event for the purposes of promoting the business, programs and events of KSA, SA, SB and sponsors and their subsidiaries. I also agree that I may be filmed and that the footage may be broadcast on television. I ACKNOWLEDGE that KSA, SA, SB and sponsors and their subsidiaries will not disclose my personal information to third parties for any other reason without my consent, unless required or authorised by law and that I will contact them if I have any queries or need to change my details. Signed: ________________________(Entrant) ___________(Date) all other competitors Signed*:____________________ (Parent/Guardian) _________(Date) * under 18y.o