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:__________________

Send to  PO Box listed below.  To avoid late charges your entry MUST BE RECEIVED BY WED BEFORE THE CONTEST    

NAME _________________________________TEL#________________      ***Please print clearly ***

BIRTHDATE ____________AGE AS OF 1/1/2014______ EMAIL ADDRESS ________________________________ ADDRESS:_______________________________CITY ___________________________ STATE ___ ZIP___________

Use your age as of January 1, 2014 for your division.

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

Check each event in which you will compete.  CHECK THE BLOCK(S) TO THE RIGHT OF THE DIVISIONS YOUR’E SURFING 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 m/f) ____Girls (14 & under) ___ Junior Women ( 15-17)____

Women (18-29) ___Ladies(30 and over) ____Menehune Longboard (14&under m/f) ___Junior Men’s Longboard (15-17) ____

Men’s Longboard (18-34) ____Masters Longboard (35-49) ____Legends Longboard (50 +) _____

Open Longboard (all ages m/f) _____Junior Women’s Longboard (15-17) ____ Women’s Longboard (18-29) ____

Ladies Longboard (30 & up)____Open Bodyboard (all ages m/f) ____Open Stand-up Paddleboard, SUP (all ages m/f) ____

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

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