ESA Contest Entry Form

CONTEST ENTRY FORM

Eastern Surfing Association Palm Beach County District

CONTEST LOCATION:_______________________________________

*Local events are open to current local ESA district members only.*

You may join or renew your ESA membership on the beach, but your

contest entry must be received by the entry deadline. Entry is limited.

ENTRY DEADLINE: Entry MUST BE RECEIVED BY 5 PM ON THE THURSDAY BEFORE THE CONTEST. Beach entry is only as an alternate, IF there is room in a heat). Entry may be

mailed in time to reach us by the deadline OR dropped off at any local ESA sponsor surf shop by the deadline. A postponed event re-opens the deadline until the Thursday before the event.

NAME _________________________________________TEL#________________

BIRTHDATE _____/_______/______ AGE ON 1-1-2006: _______

ADDRESS:_____________________________________________________

CITY ___________________________STATE ___ ZIP___________

EMAIL ADDRESS (for Local ESA news ONLY):_________________@__________

Check each event in which you will compete. REMEMBER to use your age as of January 1, 2006.

Novice Menehune____ (all surfboards, with parental supervision in the water.) No Regional competition.

Menehune (11 & under) ____ 3A Junior Men (15-17) ____

Boys (12-14) ____ Men (18-24) _____

Girls (14 & under) ____ Masters (25-34) _____

Junior Women ( 15-17) ____ Senior Men (35-44) ____

Menehune Longboard (14&under) ____ Grandmasters (45-54) ____

Women (18-29) ____ Legends Shortboard (55-64)) ____

Senior Women (30 and up) ____ Grand Legends (65+) ____

Open shortboard(all ages) ____

Junior Longboard (15-17) ____ Men’s Longboard (18-34) ____

Bodyboard (all ages) ____ Menehune Bodyboard (<14, M&F)

Senior Longboard (35-49) ____ Legends Longboard (50 +) ____

Ladies Longboard (29 and under) ____ Women’s 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. If I practice in the Contest Area, I may be disqualified.

X_______________________________ ____________________________

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

ENTRY FEE: $25.00 1ST Division + $10 FOR EACH ADDITIONAL Division.

LATE CHARGE (after Thursday) additional $10.00. MAKE CHECKS PAYABLE TO E.S.A.

E.S.A., 625 Lakeside Harbor, Boynton Beach FL 33435 +INFO : 561-734-1180

JupiterSurf.com

This page was last updated on 10/22/05.