2211 Eppinger Blvd. • Thornton, CO 80229 January 23-25, 2015 (Tournament Registration: January 1-20) Tournament Directors: Mike Coulter • 720-977-5914 • [email protected] Andrew Rodriguez • 720-977-5920 ext. 6 Icy Blast Tournament Entry Form Name:_______________________________________________________ Phone:_______________________________________________________ Email Address:_________________________________________________ Icy Blast Tournament Information Format: Conflicts (will be considered first round only, no guarantees):____________ ____________________________________________________________ Tournament format may be double elimination or pool play based on the number of entries received. Tournament Director reserves the right to re-classify, combine divisions or cancel. USAR rules apply. Players will referee their own matches. All disputes to be played over or resolved by Tournament Director. Refreshments will be served and game balls will be provided. Eye protection is mandatory! ____________________________________________________________ Daily Start Times: Friday, January 23 at Please circle one singles and/or doubles division/level below. Divisions may be combined if necessary. Single Men's A BCDNovice Single Women's A BCDNovice Doubles Men's A B 6 p.m.; Saturday, January 24 at 8 a.m. and Sunday, January 25 at 9 a.m. Start times will be emailed to all participants on Wednesday, January 21. Doubles Mixed A B Entry Fee: Singles: 417390-A1 Doubles: 417390-B1 $30 per person for one division (singles or doubles) or $55 per person for two divisions (one singles, one doubles or two doubles) Tournament Fee: $30 for one division, $55 to sign up for singles and doubles. Entry Deadline: Visa/MC/Discover Card: __ __ __ __-__ __ __ __-__ __ __ __-__ __ __ __ Registration: Tuesday, January 20 by noon. Walk-in registration at the Margaret Carpenter Recreation Center, 11151 Colorado Blvd. Phone-in registration, please call 720-977-5901. Mail-in registration: City of Thornton Icy Blast Tournament, Attn: Mike Coulter, 2211 Eppinger Blvd., Thornton, CO 80229. Registration deadline: Tuesday, January 20 at noon. Partner Name:______________________________ Partner Name:______________________________ Total amount enclosed: $ ________________________________________ Expiration Date: ________/________ Please make checks payable to CITY OF THORNTON. Registration Deadline: Tuesday, January 20 at noon. Waiver: The undersigned, for myself, my heirs, and my assigns, hereby releases the City of Thornton and any other co-sponsors, officials and staff from all claims for injury and damages the undersigned may have by reason of his/ her participation in the Icy Blast Racquetball Tournament. I acknowledge that my participation in this event, or that of my child, involves an inherent risk of physical injury to any individual undertaking such activity or damage to the property of such individual. The undersigned further agrees to hold the City of Thornton, it’s agents and employees harmless, for any other persons or property caused by participant’s involvement in this activity except to the extent such claim might be based upon the sole and exclusive negligence of the City of Thornton. This agreement shall be effective and binding upon the parties hereto for the activity above. The parties hereto acknowledge having read and understood this agreement. Participant also authorizes use of his/her name and picture to be released for use in reporting results and promoting future events. (if under 18 years of age, parent/guardian must sign) Signature___________________________________________________________________________________