Individual Registration.doc - Drexel University - Comprehensive by P83R4KN


									                      November 2 – 4, 2007
                Individual Registration Form

Name: __________________________________           Chapter: __________________

Address: ____________________________________      Apt #: ___________

City: _______________________     State: _______   Zip Code: __________

E-Mail Address: _____________________________________

Phone Number: ______________________

Please Check All That You Will Be Attending

____    Party @ Temple University             9:00 PM – 2:00 AM
____    Soccer Tournament                     12:00 PM – 4:00 PM
____    Party @ Bowling Alley                 9:00 PM – 2:00 AM

There is plenty of free housing for Inter-Chapter Brothers
____    Interested in Free Housing (Y/N)
Registration Fees:
$25        Registration Fee (includes donation to Cure Autism Now)

____       T-Shirt (Y/N) ($10.00)
____       Size

Total Cost: _________
(Make checks Payable to Phi Sigma Pi)

               Please Send Completed Forms and Payment to:

                                  Brad Youst
                                8215 Buist Ave.
                            Philadelphia, PA 19153

                  Please mail your forms by October 20th 2007

                          Please direct any questions to:

  Brad Youst: or           Julie Sterner:

* Be sure to complete the Release of Liability form
                        Release of Liability

I, and my heirs, in consideration of my participation in the Philly Cup on
November 2nd through November 4th of 2007 at any sponsored location, hereby
release Phi Sigma Pi, Temple University, Drexel University, and its officers,
employees and agents, and any other people officially connected with this event,
from any and all liability for damage to or loss of personal property, sickness or
injury from whatever source, legal entanglements, imprisonment, death, or loss
of money, which might occur while participating in this event. Specifically, I
release said persons from any liability or responsibility for the Soccer
Tournament. I am aware of the risks of participation, which include, but are not
limited to, the possibility of sprained muscles and ligaments, broken bones and
fatigue. I hereby state that I am in sufficient physical condition to accept a
rigorous level of physical activity. I understand that participation in this program is
strictly voluntary and I freely chose to participate. I understand that the University
does not provide medical coverage for me. I verify that I will be responsible for
any medical costs I incur as a result of my participation.

(Participant Name Printed)

(Participant Name Signature)


To top