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ENTRY FORM

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xxxxxxxxxxxxxParticipant Name:
xxxxxxxxxxxxxAddress: City: State: Zip:
xxxxxxxxxxxxxPhone: Email: Federation#
xxxxxxxxxxxxxToday's Date: Date of Birth:

xxxxxxxxxxxxxRider Cup Entry Fee $110.00 USD * Nationals Entry Fee $110.00 xxxxxxxEntry Deadline: All forms and fees
xxxxxxxxxxxxxNote: Team USA Riders may ride in both events for 1 fee.xxxxxxxxxxxxxxmust be received by 5:00 pm EST,
xxxxxxxxxxxxxEntry fee includes competitor banquet ticket.xxxxxxxxxxxxxxxxxxxxxxxxxFriday, July 28. A $25 per day late
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxfee will be charged thereafter.

xxxxxxxxxxxxMANDATORY COMPETITORS OFFICIALS MEETING 8:00 AM AUGUST 5 AT OWC, (ROLL CALL.)

xxxxxxxxxxxxI AM ENTERING IN RIDER CUP REPRESENTING TEAM
xxxxxxxxxxxxxxxxxVisionary Division Ripper Division Skyhanger Division

xxxxxxxxxxxxI am entering in NATIONAL CHAMPIONSHIPS Division

xxxxxxxxxxxxPractice Sets at $10 per set
xxxxxxxxxxxxSlalom How Many Sets Tricks How Many Sets xxxxxxxxxxxTOTAL PRACTICE $

xxxxxxxxxxxxBanquet Tickets: $30 adults, $15 (12 and under) How Many Adults xxx TOTAL ADULTS x$
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxHow Many Children TOTAL CHILDREN .$xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxENTRY FEE $xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxTOTAL ENCLOSED $

xxxxxxxxxxxxxSend entry form & fees to registrar Scott Ascher (Cks made out to AKA)
xxxxxxxxxxxxx1822 Marley St., Greenbay, Wi 54313 Scottascher@new.rr.com
xxxxxxxxxxxxxForms may be emailed with payment made at www.amer-kneeboard.org

xxxxxxxxxxxxxInclude Entry Form, Waiver, Bio, Proof of Federation membership, USA WS membership,
xxxxxxxxxxxxxproof of insurance (AKA membership) for foreign members competing in Rider Cup. Payment
xxxxxxxxxxxxxeither by check (USD) or online. Online registering may be available. Check www.mer-kneeboard.org
xxxxxxxxxxxxxfor availability. Need more info: Tournament Coordinator, Kenny Stuart, kneeystuart@etcmail.com              

xxxxxxxxxxxComments:
xxxxxx