UPDATED Kitesurfing Entry Form and Competitors Details2

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UPDATED Kitesurfing Entry Form and Competitors Details2 Powered By Docstoc
					                     Great Keppel Island to Yeppoon Kiteboarding & Windsurfing Event
                                 PINEFEST 8th – 9th OCTOBER 2011

Registration Form
 Competitors Details – Please print clearly
      Competitors Details – Please print clearly

Name                                                                                 Date of Birth


State                                                                                Home Region

Phone                                                                                Email –

Emergency Contact:                                                                   Phone

Kitesurfing /Windsurfing Experience                                mths              Can You Swim?

AKSA Members / CCKSA                                                Wind Surfer Member ( KBSC membership or other Y/N )

     -          th
          The 8 of October we will be going from Emu Park to Great Keppel and then on the 9th we will go from Great Keppel
          to Yeppoon ( Keppel Bay Sailing Club)
     -    The entry fee is $120.00 per person that includes boat transfers, accommodation , dinner and breakfast on the island
     -    All competitors Must be at Freedom Fast Cats Terminal by 8am sharp on the 8th October
     -    Anyone who wants to join us on Sunday the 9th can come over on freedom fast cat ($65)

* For insurance purposes all Kitesurfers must be a member of Australian Kitesurfing Association and all Windsurfers must
be a member of a sailing club or Association. Proof of membership will be required on the day.

                                                Payment Details

     -    Cash & Eftpos at the Keppel Fast Cats Terminal on the Saturday morning before departure

                                      Indemnity – Please Read Carefully

I Partake of in the Great Keppel Yeppoon Kite boarding event and other activities as scheduled, voluntarily and with full
understanding of the inherent dangers and risk associated with the sport of Kitesurfing/Windersurfing. I have a reasonable level
of fitness for a physically demanding sport and have kite control and windsurfing skills suitable for a busy competition in a public
space. My kite/windsurfer has a functional safety system and I am familiar with it’s with its use. By signing this form I indemnify
the Yeppoon Pine Festival its sponsors, interested parties such as AKSA, Windsurfing Clubs/Associations council and its
contractors, from any responsibility for damage incurred to property, injury to persons, or any legal action arising from my
participation in this competition.

Signed:                                                             Date:        /      /

                                            Insurance – Membership

I am a current financial member of AKSA, Sailing Member, Windsurfing Club/Associations

Signed:                                                            Date:     /          /

Registration Form must be returned before event or at Check-in at Freedom Fast Cats Terminal
Check in and entree fee, registration deadline is 8am 08/10/11
Please email to Web Site

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