2010 MESQUITE SENIOR GAMES REGISTRATION FORM
LAST NAME_____________________________FIRST NAME____________________ PHONE________________________________CELL______________________________________________________
MAILING ADDRESS _____________________________ CITY____________________ STATE___________________ ZIP__________ EMAIL: ___________________________________________ COUNTRY________________________
DATE OF BIRTH______________ Age GROUP (50-54) (55-59) (60-64) (65-69) (70 - 74) (75+) The age you turn in 2010
GENDER M / F SHIRT SIZE _______
SELECT GAMES YOU WISH TO ENTER
1. Archery Longbow $5_____ Recurve $5_____ Compound Fingers $5_____ Compound Release $5_____
2. Basketball Skills $5_____(includes all 3) Freethrow, Hotshot, 3-Point
3. Bowling Handicap singles $8_____ Handicap doubles $8 per bowler_____ Partner_____________________________ (must fill out separate form) Fees include alley fees. Both events $12_____ Average _____ (USBC 2009 highest 21-game average. If no USBC average, men use 170, women use 150. Entry deadline April 4, 2010.
4. Golf 18 holes $25_____ (Green Fees and cart Included)
5. Pickleball $5 ea. Men’s singles age 50-54_____ 55-59_____60-64_____65-69_____ Men’s doubles age 50-54_____ 55-59_____60-64_____65-69_____ Women’s singles 50-54_____ 55-59_____60-64_____65-69_____ Women’s doubles 50-54_____ 55-59_____60-64_____65-69_____
Mixed doubles 50-54_____ 55-59_____60-64_____65-69_____ (Doubles Partner ________________________________ (must fill out separate form) age______
6. Target Pistols: Rimfire $5________ Centerfire $5 _________ plus registration fee
7. Team Softball (Call Frank Pati 702-346-7211)
8. Track & Field 5K run $5___ 400 meter run $5___ 800-meter run $5 _____ 1500 meter run $5___ 50 meter sprint $5___ 100 meter sprint $5___ 200 meter sprint $5___ 400 meter racewalk $5___ 1500 meter racewalk $5___ standing long jump $5___ running long jump $5___ shot put $5___ javelin throw $5___ discus $5___ softball throw $5___
9. Bocce Events: $5 ______ Singles $5 ______ Doubles $5 ______ 3--person teams $5 ______ 4-person teams + registration fee
10. Sporting Clays 100 target, $40_____Bocce Events $5 Singles _____ $5 Doubles _____ $5 Three-person teams _____ $5 Four-person teams _____
11. Tennis singles age______ $5 - 50_____ 55_____60_____65_____70_____doubles $5- 50_____ 55_____60_____65_____70_____ mixed doubles $5 - 50_____ 55_____60_____65_____70_____
(Doubles Partner_______________________________________________________________________) (Mixed Doubles Partner _________________________________________________________________) (Must fill out separate form) age______
You must be the age of the category that you turn this year. For more information call; (702) 346-0244. Deadlines for guaranteed entry depends on individual event.
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SUMMARY OF FEES: Standard Registration Fee $20__________ Total of Entry Fees: ________________ Donation (thank you) _________________ Grand Total ________ Note: Softball does not require standard fees. Make checks payable to Mesquite Senior Games and mail to: PO Box 2079, Mesquite, NV 89024 |
Amateur Athletic Waiver and Release of Liability For being allowed to participate in the Mesquite Senior Games program, the undersigned participant agrees to all of the following: To inspect facilities and equipment in use, and if unsafe, to notify the MSG supervisor and refuse to participate. He/She acknowledges that each participant will engage in activities that involve risks and accepts personal responsibility for all posible consequences including injury or death; agrees not to sue Mesquite Senior Games, its officials, representatives, sponsors and participants for death, injury or damage to property caused, or allegedly caused in whole or in part by negligence of the releasee. He/She warrants that he/she is in good health and condition and has contacted their physician to learn this fact. MSG officials or their designated medical professionals have permission to provide emergency medical treatment if needed. He/She grants the MSG and its sponsors the right to use their names and pictures and video or audio taken during to Mesquite Senior Games. |
Signed_______________________________________________________Date_________________________
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