ENTRY FORM - MASTERS WEST REGION THROWS CHAMPIONSHIPS

Sex *

Female

Male

Athletic Waiver Release: In Consideration of acceptance of my entry, I herby for myself and executors waive, release and forever discharge any and all claims for damages which I may have, or hereafter accrue, against Mesa Community College, USATF, USATF Arizona, AZ Desert Throwers, David Bickel and all other sponsors and sports facilities or their officials or agents, for any damages which may be suffered by me. I certify that I am in good health and that my level of training is such that I am prepared to compete in this event. I agree to allow AZ Desert Throwers and assigns to use my likeness, picture, and/or written or verbal comments, in whole or in part for educational/promotional purposes. My typed name and date below is my signature and indicates understanding and acceptance of the above described release. *

USATF Number: *

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Address *

Voluntary Contribution Amount:

Last Name: *

MASTERS WEST REGION THROWS CHAMPIONSHIP (A USATF SANCTIONED EVENT) ENTRY FORM: *

City: *

Zip Code: *

Events - Check All That Apply *

Throws Pentathlon - $30.00

Ultra Weight Pentathlon - $30.00

Weight Throw - $5.00

Super Weight Throw - $5.00

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First Name: *

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Birthdate *

Todays Date *

How Many Will Attend The Post Ultra Weight Party: *

Age: *