PHILLIP ISLAND KNEEBOARD PRO

March 14th & 15th 2020NAME __________________________________________ D.O.B. __/__/____

ADDRESS ___________________________________________________________________

STATE ______ POSTCODE ________ Email __________________________________

Tel (____) _____________________ Mobile _____________________________________

ALL ENTRANTS MUST BE CURRENT FINANCIAL MEMBERS OF SURFING AUSTRALIASURFING AUSTRALIA MEMBERSHIP NUMBER__________ Membership state __________

CONTEST IS 5 STAR RATED. MAXIMUM OF 64 ENTRIESALL ENTRANTS COMPETE IN THE OPEN DIVISION

Competitors meeting Friday 13th March at the North Pier Hotel, Cowes 7.30 pmADDITIONAL DIVISIONS

Please tickCadets ____ (under 16 at 1/1/2020) Juniors____(under 19 at 1/1/2020 Womens ____ (all ages)

ENTRY FEE $90 Cadets Juniors & Women $30SEND ENTRIES TO : Phillip Island Kneeboard Pro. 5 HOLLYDENE COURT COWES 3922.

ENTRIES CLOSE FRIDAY 6th. MARCHAustralia Post Money Order or Direct Payment into Bendigo Bank account

No personal cheques.Please Tick if using Direct Payment.

_______ EFT DIRECT PAYMENTS : Phillip Island Kneeboard Pro: BSB 633 108 Account No. 1372 09524

Amount $_________ Date Paid ___/___/_____Please use your name as a reference on the deposit

YOU MUST STILL POST AN ENTRY FORM.

In applying to compete in the Phillip Island Kneeboard Pro 2020 (“the Event”): IACKNOWLEDGE that there are inherent dangers associated with the sport of surfing and my participationin the Event and that serious accidents can happen which may result in me being injured. To the full extentpermitted by law, I agree to ABSOLVE AND INDEMNIFY Kneeboard Surf Australia INC ("KSA"), Surfing

Australia (“SA”) and its affiliated State Branches (“SB”) and sponsors and their subsidiaries, directorsofficers and employees from and against any and all liability for injury, loss or damage however caused

arising from my participation in the Event. I RELEASE AND INDEMNIFY AND WILL KEEP INDEMNIFIEDKSA, SA, SB and sponsors and their subsidiaries, directors, officers and employees from all claims arising

from my participation in the Event. I CONSENT to KSA, SA, SB and sponsors and their subsidiariescollecting and using my personal information for the purpose of administering and promoting the Event. Iagree that KSA, SA, SB and sponsors and their subsidiaries may use images of my participation in the

Event for the purposes of promoting the business, programs and events of KSA, SA, SB and sponsors andtheir subsidiaries. I also agree that I may be filmed and that the footage may be broadcast on television. I

ACKNOWLEDGE that KSA, SA, SB and sponsors and their subsidiaries will not disclose my personalinformation to third parties for any other reason without my consent, unless required or authorised by law

and that I will contact them if I have any queries or need to change my details.

Signed: ________________________(Entrant) ___________(Date) all other competitorsSigned*:____________________ (Parent/Guardian) _________(Date) * under 18y.o