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Entry 2005
VICTORIAN MASTERS BASEBALL CARNIVAL
Geelong, 1 - 3 April 2005
Entry booklets and other information will be mailed out to Team Managers and other interested parties by 20 January. If required, you may print and complete the following pages for Entry purposes.
Please note, to qualify for a particular age grouping, a player must have reached that age at any time during the year of competition (IE by 31 December 2005).
ENTRY BOOKLET
· This booklet may be used for individual or team entry. If sufficient space is not available or if players are to be added, further Player details can be attached or forwarded prior to the close of entry. Team Managers are asked to send all entries together if possible. Photocopies are accepted.
· Team Managers are asked to emphasise to players, in signing the Entry, that each has accepted the Indemnity Disclaimer on the final page.
· CLOSING DATE FOR ENTRY: Friday 25 February 2005
· Entry and payment required should be forwarded to:
Victorian Masters Baseball Carnival
c/o 409A South Street
Ballarat VIC 3350
(Telephone: 03 53329202 Email: movfin@excite.com)
· Total entry per player is $ 40.00.
· Cheques or Money Orders to be made out to Ballarat Golddiggers. Please do not send cash through mail. Receipts will be issued prior to the Carnival. Credit cards cannot be processed.
· TEAM NAME (if known at time of entry): _______________________________________
· AGE GROUP (35+, 40+, 45+): ________________________________________________
OFFICE USE ONLY
Number of entries: ________ Payment received: ___________ Date: ____________________
PLAYER DETAILS
(must be completed and signed by each player)
______________________________________________________________
FIRST NAME: ________________ SURNAME: _____________________
DATE OF BIRTH: _______________ AGE AT 31/12/05 (years): ______ M/F (circle)
ADDRESS: ________________________________________________________________________
STATE: ______________ POSTCODE: ________ EMAIL: _____________________________
HOME PHONE: _________________________ WORK PHONE: _________________________
EMERGENCY CONTACT: _________________________________________________________
PLAYER SIGNATURE: ___________________________________ DATE: _________________
______________________________________________________________
FIRST NAME: ________________ SURNAME: _____________________
DATE OF BIRTH: _______________ AGE AT 31/12/05 (years): ______ M/F (circle)
ADDRESS: ________________________________________________________________________
STATE: ______________ POSTCODE: ________ EMAIL: _____________________________
HOME PHONE: _________________________ WORK PHONE: _________________________
EMERGENCY CONTACT: _________________________________________________________
PLAYER SIGNATURE: ___________________________________ DATE: _________________
______________________________________________________________
FIRST NAME: ________________ SURNAME: _____________________
DATE OF BIRTH: _______________ AGE AT 31/12/05 (years): ______ M/F (circle)
ADDRESS: ________________________________________________________________________
STATE: ______________ POSTCODE: ________ EMAIL: _____________________________
HOME PHONE: _________________________ WORK PHONE: _________________________
EMERGENCY CONTACT: _________________________________________________________
PLAYER SIGNATURE: ___________________________________ DATE: _________________
FIRST NAME: ________________ SURNAME: _____________________
DATE OF BIRTH: _______________ AGE AT 31/12/05 (years): ______ M/F (circle)
ADDRESS: ________________________________________________________________________
STATE: ______________ POSTCODE: ________ EMAIL: _____________________________
HOME PHONE: _________________________ WORK PHONE: _________________________
EMERGENCY CONTACT: _________________________________________________________
PLAYER SIGNATURE: ___________________________________ DATE: _________________
==============================================================
FIRST NAME: ________________ SURNAME: _____________________
DATE OF BIRTH: _______________ AGE AT 31/12/05 (years): ______ M/F (circle)
ADDRESS: ________________________________________________________________________
STATE: ______________ POSTCODE: ________ EMAIL: _____________________________
HOME PHONE: _________________________ WORK PHONE: _________________________
EMERGENCY CONTACT: _________________________________________________________
PLAYER SIGNATURE: ___________________________________ DATE: _________________
==============================================================
FIRST NAME: ________________ SURNAME: _____________________
DATE OF BIRTH: _______________ AGE AT 31/12/05 (years): ______ M/F (circle)
ADDRESS: ________________________________________________________________________
STATE: ______________ POSTCODE: ________ EMAIL: _____________________________
HOME PHONE: _________________________ WORK PHONE: _________________________
EMERGENCY CONTACT: _________________________________________________________
PLAYER SIGNATURE: ___________________________________ DATE: _________________
==============================================================
FIRST NAME: ________________ SURNAME: _____________________
DATE OF BIRTH: _______________ AGE AT 31/12/05 (years): ______ M/F (circle)
ADDRESS: ________________________________________________________________________
STATE: ______________ POSTCODE: ________ EMAIL: _____________________________
HOME PHONE: _________________________ WORK PHONE: _________________________
EMERGENCY CONTACT: _________________________________________________________
PLAYER SIGNATURE: ___________________________________ DATE: _________________
==============================================================
FIRST NAME: ________________ SURNAME: ___________________
DATE OF BIRTH: _______________ AGE AT 31/12/05 (years): ______ M/F (circle)
ADDRESS: ________________________________________________________________________
STATE: ______________ POSTCODE: ________ EMAIL: _____________________________
HOME PHONE: _________________________ WORK PHONE: _________________________
EMERGENCY CONTACT: _________________________________________________________
PLAYER SIGNATURE: ___________________________________ DATE: _________________
==============================================================
FORWARD TO: Victorian Masters Baseball Carnival
c/o 409A South Street Ballarat VIC 3350
DISCLAIMER
I/We the above-signed, agree to respect the spirit of Masters sport and to abide by the Rules of the Tournament. I/We agree to indemnify and hold harmless the Ballarat Baseball Association, the Golddiggers Sub-Committee, Geelong Baseball Association, Victorian Masters Baseball Carnival and its organisers and agents in respect to any damage or injury caused to property and persons arising from events and functions conducted for the Carnival not covered under Public Liability. I/We accept that no sports injury or personal accident insurance is provided by the Victorian Masters Baseball Carnival and I/We acknowledge that I/We have been required by event organisers to hold current VBA/VPBL Registration and encouraged to obtain any further injury or accident insurance that I/We may desire.
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