2014 Torrance County 50+ Games ENTRY FORM

Name Mailing Address Email Date of Birth Age as of 12/31/14 First Year in Sr. Olympics? YES NO (complete and turn in with the Event Registration page) Phone

Entry Fee check one: 1 sport $5 ___ 2-3 sports $8___ 4 or more sports $10____ Entry Fee - Cash ___ Check ___ (payable to Torrance County Senior Olympics) Spouse name (or emergency contact) Phone number(s) of emergency contact
All persons age 50 or older by 12/31/2014, are encouraged to participate in the Senior Olympic program. You must qualify by participating in these Local Games to be eligible to compete in the NM State Senior Olympics in Roswell July 16 20. YOUR REGISTRATION FEE, THIS COMPLETED ENTRY
FORM AND THE EVENT REGISTRATION PAGE MUST BE SUBMITTED TO

JERRY MELARAGNO, P.O. BOX 496, MOUNTAINAIR, NM 87036 FIVE DAYS PRIOR TO YOUR FIRST EVENT. On-site (walk-in) registrations will be accepted at a cost of $5 for each sport. Liability Waiver
In consideration of being accepted in this event, I, the undersigned, intending to be legally bound, do hereby, for myself, my heirs, my personal representatives and assigns, waive, release, and forever discharge any and all rights and claims for damages which I may have or may hereafter occur to me against PMS, Torrance County, any facilities holding competition, NM Senior Olympics, Inc., or any other NM Senior Olympic Sponsor, or their officers, agents, representatives, successors, assigns or any other corporations or individuals associated with the NM Senior Olympics from any and all damages, claims, injuries or actions sustained or suffered in connection with my association or entry in or arising out of my participation in said event. If in doubt as to my physical condition to engage in the event, I have been advised to seek the advice of a competent physician, and to abide by his/her advice. I attest and verify that I have full knowledge of the risks involved in this event and that I am physically fit and sufficiently trained to participate in this event. Further, I grant full permission to any and all the foregoing to use my likeness participating in this event without obligation or liability to me. Further, I agree to abide by all rules and regulations of the NM Senior Olympics Games, Inc., to observe all rules of play, to exercise good sportsmanship and follow all written and oral instructions given by authorized personnel of the Games. I agree that failure to so act may result in my disqualification or suspension from the Games. Signature Date