Alabama Division 2017 Junior Olympics Qualifier

ALABAMA DIVISION 2017 JUNIOR OLYMPICS QUALIFYING TOURNAMENT Qualification: Fencers must be U.S. citizens or permanent residents of the United States and current competitive members of the USFA (onsite membership registration will not be available at the event). Fencers must meet the age requirements of the USFA Championships at the time of the qualifier in order to compete in that qualifier. Fencers must belong to the Alabama Division of USFA. Cadet: fencers born between 2001 and 2004 Junior: fencers born between 1998 and 2004 Fees: $15 registration fee plus $10 for each event on or before 12/05/2017. Please register at this site first, but you need mail the signed form with payment (check only) to: Wesley Brand 106 Heather Way Pelham, AL 35124 Entry Form and payment must be postmarked on or before December 5th, 2017 for registration. Email Wesley Brand at wesley@codethattalks.com after you mail the form. Events Scheduled: (Check-in and fencing time will be updated two days after the late registration is closed) Cadet (U17) Women's Epee Cadet (U17) Women's Foil Cadet (U17) Women's Saber Cadet (U17) Men's Epee Cadet (U17) Men's Foil Cadet (U17) Men's Saber Junior (U20) Women's Epee Junior (U20) Women's Foil Junior (U20) Women's Saber Junior (U20) Men's Epee Junior (U20) Men's Foil Junior (U20) Men's Saber Fencing time for each event will be decided after the registration is closed. If competition is required, it will take place on 12/9. Preregistration opens on 11/1/2017. Preregistration closes on 12/5/2017. ------------------------------------- Cut Here for Registration Form --------------------------------------------                                                ALABAMA DIVISION                                     2017 JUNIOR OLYMPICS QUALIFIER                     December 9, 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 (onsite membership registration will not be available at the event). Fencers must meet the age requirements of the USFA Championships at the time of the qualifier in order to compete in that qualifier. Fencers must belong to the Alabama Division of USFA. *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 on or before 12/11. Men’s Epee Men’s Foil Men’s Sabre Women’s Epee Women’s Foil Women’s Sabre Weapon RatingCadet (birth year 2001-2004)Junior (birth year 1998-2004) 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 (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)