ENTRY FORM – Wandiyali ATSI Indigenous Classic
All competitors must have good swimming ability and surf sense
NAME
ADDRESS: POST CODE:
DATE OF BIRTH: PHONE No: ......
ENTRY FEE: $110 – Open division (GST inclusive)
Free entry for Women’s, Junior & Open Longboard divisions
Payable by Cheque/Money Order (Do Not Send Cash)
Only entry forms with cheques or money orders attached will be considered for entry.
Entry payable to Wandiyali ATSI
Circle division entered - OPEN WOMENS JUNIOR OPEN LONGBOARDS
In applying to compete in the Indigenous Classic (“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 WSL Australasia (“WSLA”), Surfing Australia (“SA”), DNSW , Surfest Ltd (“SL”), Vintcorp Pty Ltd (“VL”), Wandiyali ATSI) and Surfest (“S”) their directors, state branches, officers and employees from and against any and all liability for injury, loss or damage however caused arising out of my participation in the Event. I agree to RELEASE AND FOREVER DISCHARGE AA, SA, SL, VL, EP and S from all claims that I may have or may have had but for this release arising from my participation in the Event. I AGREE that WSLA, SA ,SL, VL, EP and S retains the right to utilise images of my participation in the Event for the purposes of promoting WSLA, SA , SL, VL, EP and S, their programs and events. By entering this competition you agree that you may be filmed and that the footage may be broadcast on television. I have read, understood, acknowledge and agree to the above declaration including the warning, release and indemnity.
Signed: Date:
Name:
Where the applicant is under 18 years of age this form must also be signed by the applicant’s parent or legal guardian.
I, am the parent or guardian of the applicant. I expressly agree to be responsible for the applicant’s behaviour and agree to personally accept the conditions set out in this application and declaration including the provision by me of a release and indemnity in the terms set out above.
Parents Signature: Date:
(where applicant under 18 y.o)
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WANDIYALI ATSI INDIGENOUS CLASSIC
MEREWETHER BEACH
Thursday 16 & Friday 17 February 2017
TOTAL PRIZEMONEY - $22,000
Open Winner $6,000; 2nd $4,000; 3rd $2,000; 4th $1,500; Equal 5th $500; Equal 7th $250
Women’s Winner $1500; 2nd $750; 3rd $500; 4th $250
Junior – Winner $1000; 2nd $500; 3rd $300; 4th $200
Open Longboard - Winner $1000; 2nd $500; 3rd $300; 4th $200
ENTRY FEE: $110 – Open division (inclusive of GST)
Free Entry – Women, Junior & Open Longboard divisions
Cheques/money orders payable to: Wandiyali ATSI
POST TO: Surfest PO Box 441 The Junction Newcastle 2291
Enquiries: Stan Moylan Ph 0401519799