Alabama Division 2017 Summer Nationals Qualifier

To participate in the Alabama Division Summer National Qualifier sign up on askFred AND mail entry form and payment to Alabama Division, c/o Wesley Brand, 106 Heather Way, Pelham AL 35124. You must be a competitive member of the Alabama Division of the USFA to compete in this tournament. This tournament qualifies fencers to fence in Div 2, Div 3 and Y14 events at Summer Nationals ** must be postmarked by 5/3/17** Email Wesley Brand at wesley@codethattalks.com for questions about registration and to verify your form has been received. If you are mailing it close to the deadline email Wesley Brand to let him know your form is on its way. $15.00 registration fee plus $10.00 per each event. Fencers must be U.S. citizens or permanent residents of the United States and current competitive members of the USFA (registration WILL NOT be available at the event). Fencers must meet the age and classification requirements of the USFA Championships at the time of the qualifier in order to compete in that qualifier. Events Scheduled: Y14 Women's Epee Y14 Women's Foil Y14 Women's Saber Y14 Men's Epee Y14 Men's Foil Y14 Men's Saber C & Under Senior Women's Epee D & Under Senior Women's Epee C & Under Senior Women's Foil D & Under Senior Women's Foil C & Under Senior Women's Saber D & Under Senior Women's Saber C & Under Senior Men's Epee D & Under Senior Men's Epee C & Under Senior Men's Foil D & Under Senior Men's Foil C & Under Senior Men's Saber D & Under Senior Men's Saber Preregistration opens on 02/26/2017. Preregistration closes on 05/03/2017. ------------------------------------- Cut Here for Registration Form --------------------------------------------                                                ALABAMA DIVISION                                     SUMMER NATIONALS QUALIFIER                     May 6, 2017 (Saturday) @ Birmingham Fencing Club Qualification: Fencers must be U.S. citizens or permanent residents of the United States and current competitive members of the USFA (registration will not be available at the event). Fencers must meet the age and classification requirements of the USFA Championships at the time of the qualifier in order to compete in that qualifier. *All information is required, no field is left blank Name:_____________________________ Club:_____________________________________ Address:_____________________________________________________________________ Birth Date:_________________ Sex:_________ USFA number:_________________________ Email Address:_________________________________________________________________ (email addresses will be used for communication regarding this tournament only) Fees ($15 registration fee plus $10 for each event; include weapon rating for each even): Men’s Epee Men’s Foil Men’s Sabre Women’s Epee Women’s Foil Women’s Sabre Weapon Rating Youth 14 (birth years 2002-2005)Division II (C & under)Division III (D & under) Those planning to compete in Veteran level events at Summer Nationals must have competed in NAC, ROC, or must enter the D2 or D3 events, depending on weapon rating, in the Alabama Division Qualifying Tournament in their weapon. Total Fees: $___________________________________ Please make check or money order payable to the Alabama Division of USFA Mail to:               Wesley Brand, 106 Heather Way, Pelham, AL 35124 Regular Entry Form and payment must be postmarked on or before May 3, 2017. (Note: if mailing your form close to a deadline, please email Wesley Brand at wesley@codethattalks.com that your registration is on the way.) Waiver: I hereby waive and release all rights and claims and claims for damages I may have against the Alabama Division of the US Fencing Association, Birmingham Fencing Club, the United States Fencing Association, the officials, managers, sponsors, and other participants from any and all liabilities arising from illness, losses, injuries, or damages I may suffer as a result of my participation in the Alabama Division Summer Nationals qualifying fencing tournament. I attest and verify that I am physically fit and have sufficiently trained for this competition. I further waive all rights to any photographs, videotapes, recordings or any other recordings of this event for any purpose. I understand and appreciate that participation in the sport of fencing carries a risk to me of serious injury, including permanent paralysis or death. Signature (if under 18, parent or guardian must sign) ___________________________________________________ Date ______________ Consent for Medical Treatment: I give my consent to representatives of Birmingham Fencing Club to obtain medical care from physicians, clinics or hospitals for any illness and/or injury that could arise during the Alabama Division Summer Nationals qualifying fencing tournament. Name of Person to contact in an emergency: _________________________________ Relationship:_____________________ Phone Number: ________________________ Signature: __________________________________________ Date: ______________ (If under 18, parent or guardian must sign)