MERIMBULA BOARDRIDERS

SOUTH EAST DEVELOPMENT COMPETITION

Entry Form

I _____________________ (please use capitals) wish to enter the ‘South East Development Boardriding Competition' in the following division (please choose from the number for the division described above) ______.

My date of birth is _____________.

My address is:

_____________________________________________________

I enclose $40 / cheque (please circle) for entry, on the understanding that places within each division are limited by numbers and that places will be offered to the first to enter.

I further agree to release Merimbula Boardriders Inc. and all associated sponsors and office bearers from liability for any injury sustained whilst competing in this event.

(Please mail to ‘Core Boarding' Toalla St , Pambula, 2549').

Signed: _____________ (surfer) / _______________ (parent if in u16s).