Varsity, Girls and Youth Divisions

Name_________________________________Birthdate______________

Grade in School_______________

***Please enter me in the ______________________Age Division & ____________pound Weight Class***

(See tournament information for age divisions/weight classes)

Address______________________________________________________________________________

City________________________________________________State____________ZipCode__________

Phone_(______)_(______)_(______________)

CLUB/TEAM________________

e-mail_________________

In consideration of your acceptance of my entry, the undersigned: 1. Wrestlers and parents agree that prior to participating, each will inspect the facilities and equipment being used, and if they believe anything to be unsafe, they will immediately advise us of such condition(s) and refuse to participate. 2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability, death, severe social and economic loss which might result not only from their actions, inactions (s) or negligence, but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time. 3. Assume all the forgoing risks and accept personal responsibility for damages following such injury, permanent disability or death or financial loss. 4. In full comprehension and complete understanding of the foregoing warning of risk of injury, death, and/or financial loss, I and my legal heirs do hereby discharge, waive and release and covenant not to sue for any and all claims for damages I may have against the CNYPIN2WIN (Wrestling club) Inc. Gene Mills, Pin2win Inc, SUNY Oswego and/or all tournament officials, sponsors, or administrators for any and all injuries suffered by me in connection with said tournament.

Signature of parent or legal gardian:____________________________________Date_________________

_________________________________________________________

__________________________________________________Place Finish_______________

(Wrestler’s Signature) (I Qualified for the 2003 Eastern Nationals at the above Tournament)

 ****THE ABOVE INFORMATION IS MANDATORY, OR YOUR ENTRY WILL NOT BE ACCEPTED****

(If invalid weight is listed, application will be returned)

REGISTRATION FEES

ENTRY FEE: First entry @ $30.00 =_____

ADDITIONAL ENTRIES (Same Family) @ $25.00 =_____

T-SHIRTS: YOUTH LARGE_____ADULT SIZES: MEDIUM_____LARGE_____XL_____XXL_____ @ $15.00 =_____

SWEATSHIRTS: adult Sizes: Small_____Medium_____Large_____XL_____XXL_____ @ $25.00 =_____

No Insurance card required this year. Total = $________

1. Copy of birth certificate/drivers license/learners permit: proof of date of birth must be enclosed (do not send original)
   
2. Make sure you have correctly indicated the age group and weight class you wish to be entered in. Make sure the age/weight class you indicate is a valid tournament class and not necessarily the age/weight you qualified at, as our age/weight classes may be different. (To change weight classes, see tournament information.) There will be no change of weights after March 29, 2003.
   
3. Enclose a check or money order (do not send cash) for your entry fee, or shirt order if applicable. (One check is fine)

   No refunds once application is processed. Make checks/money order payable to CNY Pin2Win Wrestling Club, Inc. and mail to: Tournament Director: George Burkinshaw PO Box 215, Phoenix, New York 13135 Tel. 315-689-6645

4. For questions and information on Girls division call ED Blaseczinski (315-963-3287)