NEW ENGLAND LONGBOARD CLASSIC
Sunday, June 1, 2008 – 11 am
Nantasket Beach – Hull, Mass.

ENTRY FORM

Divisions:

Men                                                      Women                                         Paddleboard Race (if no waves)

• 13 years and under                        o      13 years and under
• 14-19                                            o      14-19

o            20-29                                        o          20-29
o            30-39                                        o          30-39
o            40-49                                        o       40 and over
o            50 and over

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Name:  __________________________________________  Street Address:  _______________________________________

City:  __________________   State: ____   Zip Code:  __________   Phone:  ____________   E-mail:  ___________________

Sex:   Male ________   Female  ________       Age:  ____________         Date of Birth:  __________________________

Do you have a history of any medical disorders?  If yes, please explain.    YES  _____           NO  _____
_______________________________________________________________________________________

Do you want to serve as a judge?       YES  _____           NO  _____

IN CASE OF EMERGENCY, PLEASE NOTIFY:

Name:  _____________________________________________________________________________

Complete Address:  ___________________________________________________________________

Telephone:  _______________________________________ Relationship:  ____________________

o            Check if ESA Member

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In consideration of accepting this application, I, the undersigned, intending to be legally bound, hereby, for myself, my heirs, executors, and administrators, waive, release, and hold harmless forever, the Town of Hull, the New England Longboard Invitational, and all sponsors, organizers, and officials of said program, their agents, servants, and/or employees, whether compensated or uncompensated, their assigns or successors, from any and all claims for personal injury, injury to personal property, theft and injury by third parties, and other claims and losses arising from my participation in said program.  I attest and verify that I am physically fit and have sufficiently trained for the completion of this program.  I have read and understand the foregoing release.

________________________________________________________________________________________
Signature of Entrant

_____________________________________________                         ____________________________________
Signature of Parent/Guardian if under 18 years old                                                                          Date

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