3 V 3 SUPER CHALLENGE TOUR 2003

 South West Florida  APPLICATION    November 15/16, 2003   Fort Myers, Florida USA

(deadline Friday Nov 7, 2003)

Team Name: _________________________________________Contact Name___________________________

 

Address:_____________________________ City:_____________________ State____ Zip__________

 

Phone:_____________________ Email (must have) ____________________________________

 

AGE GROUP  (U6__) (U7__)  (U8__)  (U9__)  (U10__)  (U1__)  (U12__)  (U13__)  (U14__)  (U15__) (U16__)  (U17__)  (U18__)  (U19__)

 

 CHECK ONE:  BOYS/COED[   ]   GIRLS[   ]              CHECK ONE:  REC[  ]   COMP[  ]    ( U10 and younger will play one division )

 

ADULTS:      [  ] COED          [  ] ADULT OPEN REC          [  ] ADULT OPEN COMP           [  ] OVER 30           [  ] WOMEN

   

CAPTAIN - player 1       Birthdate MM / DD / YYYY  male[  ] female[  ]

Player 2                Birthdate MM / DD / YYYY  male[  ] female[  ]

Name

 

Name

 

Address

 

Address

 

City/State/Zip

 

City/State/Zip

 

Phone Number

 

Phone Number

 

Email

 

Email

 

T-Shirt Size

     YL      S      M     L      XL

T-Shirt Size

     YL      S      M     L      XL

 

 

 

 

 

Player or Parent/Guardian (if player is under 18)

SIGNATURE

 

Player or Parent/Guardian (if player is under 18)

SIGNATURE

Player 3                           Birthdate MM / DD / YYYY  male[  ] female[  ]

Player 4                   Birthdate MM / DD / YYYY  male[  ] female[  ]

Name

 

Name

 

Address

 

Address

 

City/State/Zip

 

City/State/Zip

 

Phone Number

 

Phone Number

 

Email

 

Email

 

T-Shirt Size

     YL      S      M     L      XL

T-Shirt Size

     YL      S      M     L      XL

 

 

 

 

 

Player or Parent/Guardian (if player is under 18)

SIGNATURE

 

Player or Parent/Guardian (if player is under 18)

SIGNATURE

Player 5                           Birthdate MM / DD / YYYY  male[  ] female[  ]

Acceptance of Sportsmanship, Responsibility, and Waiver:  I know that participating in the strenuous activity of Soccer is potentially hazardous. I assume all risks associated with playing in this event including, but not limited to, falls, contact with other participants, effects of the weather, and the condition of the playing surface, all such facts being known and appreciated by me. Knowing these facts, and in consideration of your accepting my entry, I hereby for, my heirs, executors, administrators or anyone else who might bring claims on my behalf covenant not to sue, and waive, release, and discharge, Florida Challenge Sports Events, Inc., Pinnacle Sports Productions, all charities benefiting from this event , event employees, and any and all sponsors, including their agents employees, assigns or anyone acting on their behalf, from any and all claims of liability for death, personal injury, or property damage of any kind or nature whatsoever arising out of or in the course of my participation in this event.  This release and Wavier extends to all claims of every kind or nature of me or my likeness from this event for any purpose. Applications of minors will be accepted only with parents or guardians signature. I hereby grant full permission for event organizers to record any or all of my participation in this event for photos, motion pictures, tv, radio, recordings, videotapes, and other media known and unknown, and to use them, no matter by whom taken, in any manner for publicity, promotions, advertising, trade or commercial purposes, without any reimbursements of any kind due to me. I also realize that I am responsible for my own conduct of play. I vow to present myself and represent my team in a sportsmanlike manner. In the event that I fail to do so , I realize that both myself and my team may be ejected from the tournament without a refund.

Name

 

Address

 

City/State/Zip

 

Phone Number

 

Email

 

T-Shirt Size

     YL      S      M     L      XL

 

 

 

Player or Parent/Guardian (if player is under 18)

SIGNATURE

$140 ($130 before Nov 5) non refundable entry fee must accompany your application form.  Make check or money order payable to: "CHALLENGE SPORTS".  Drop off completed application form with your full payment to: CHALLENGE SPORTS,  C/O , or mail to:  CHALLENGE SPORTS, attn: SouthWest Florida 3v3, 2440 Michigan St., Melbourne, FL 32904.

For Credit Card Payment (fax to (321) 951-7475)  please check one:

 MasterCard         Visa             American Express

  

Card # _______________________________ Exp Date __________

Print Name: __________________________________

Address: ____________________________________

Signature: ______________________________