CHECK YOUR MEMBERSHIP EXPIRATION DATE! RENEW IF NEEDED.

INDIVIDUAL CONTEST ENTRY FORM – Central Florida District, ESA –  COPY FOR EACH CONTEST ENTRY.

CONTEST DATE:_______________ CONTEST LOCATION:__________________

MUST BE RECEIVED BY WED BEFORE THE CONTEST

Please print clearly so all information is recorded correctly.

NAME _________________________________TEL#________________

BIRTHDATE ____________AGE AS OF 1/1/2012______ ADDRESS:_____________________________________________________

CITY ___________________________STATE ___ ZIP___________

EMAIL ADDRESS __________________________________

ARE YOU UNDER 18? THEN A PARENT/GUARDIAN’S SIGNATURE IS REQUIRED ON THIS ENTRY FORM!!

Use your age as of January 1, 2012 for your division.you must surf in your age division. no surfing up

Check event(s) in which you will compete.CHECK THE BLOCK(S) TO THE RIGHT OF THE DIVISIONS YOUR’E IN!!

Menehune (11 & under) ___ Boys (12-14) ___ Junior Men (15-17) ___ Men (18-24)___

Masters (25-34) ____ Senior Men (35-44) ____Grandmasters (45-54) ____

Legends Shortboard (55-64)) ____Grand Legends (65+) ____ Open Shortboard(all ages) ____

Junior Longboard (15-17) ____Men’s Longboard (18-34) ____ Masters Longboard (35-49) ____

Legends Longboard (50 +) _____ Open Longboard (all ages) _____

Menehune Longboard(14&under)___ Bodyboard (all ages) ____Girls (14 & under) ___

Junior Women ( 15-17)___Women (18-29) ___Ladies(30 and over) ____

Women’s Longboard (29 and under) ____ Ladies Longboard (30 & up)____

In consideration of acceptance of my application, I hereby release the Eastern Surfing Association (E.S.A.),sponsors, their members, agents, successors and assigns, and any other persons or organization officially connected with their competition from any and all liability for any and all injuries or damages whatsoever arising from my participation of presence at their competition. Release is also given for the use of photos, film, or videotape. I agree to abide by all the rules and regulations involved in this event. I understand that if I do not comply with the expected rules, regulations and conduct myself in a sportsmanlike manner, I will be disqualified with a forfeiture of all entry monies. Furthermore, I agree to keep myself posted on any schedule changes that may occur and understand it is my responsibility to do so.

_______________________________ ____________________________ Competitors Signature Parent or Guardian if under 18 years of age

ENTRY FEE: $25.00 1ST EVENT (ADD $10 FOR EACH ADDITIONAL EVENT). LATE CHARGE $10.00

MAKE CHECKS PAYABLE TO E.S.A.- mail to ESA-CFL . PO Pox 320328 . Cocoa Beach, FL 32932-0328


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