Team Name: __________________________________ Contact Person: _____________________________
Address: _________________________________________ City/State/Zip____________________________
Phone: _______________________ E-mail: _____________________________________________________
Payment Information
The team registration fee of $180 has been included in the form of -Cash- or -Check- or -Credit- (circle)
Card Type: Visa MasterCard American Express Discover
Name on Card: ________________________________________________________
Card Number: _________________________________ Expiration: _____________
Complete Billing Address (for this card): ________________________________________________________
________________________________________________________
Cardholder’s Signature: ________________________________________________________
I understand that the sport of volleyball has inherent risk and participation may lead to injury or even death. I have willingly entered into this activity and accept these risks as my own. I am aware that photographs and video may be taken at this event and I acknowledge my permission for my image to be used in order to promote future events and document this one on-line, in print or via any other media format. I release Nicole Stewart, Airway Lanes & Lounge and all entities therein from any liability for any injuries that may result from my participation.
ANY INDIVIDUAL WISHING TO PLAY MUST SIGN THIS WAIVER FORM.
ANY PLAYERS WHO HAVE NOT SIGNED WILL NOT BE PERMITTED TO PLAY UNTIL THEY HAVE DONE SO.
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