OUR SPONSORS PLATINUM GOLD BRONZE. Correct as at time of printing. Duttons Mitsubishi & Hyundai Murray Bridge.

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Flora Richards
6 years ago
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1 S E M A G N O I T A R T S I G E R

2 OUR SPONSORS PLATINUM GOLD Duttons Mitsubishi & Hyundai Murray Bridge BRONZE 2 Correct as at time of printing

3 INDIVIDUAL ENTRY FORM ENTRY FORM Please complete the form and return to; Murray Bridge Masters Games, 2 Seventh Street, Murray Bridge SA 5253 You can also register online at Each individual participant should complete his form and register with payment. For team sports marked with a #, the team organiser also needs to complete and submit an entry form. PERSONAL DETAILS MR / MRS / MS Given Name: Surname: Preferred Name: Phone: Mobile: Address: State: Postcode Date of Birth: / / Are you of Aboriginal or Torres Straight Islander descent? Age at 31/12/2017 : Male / Female Do you have any medical condition(s) That the event organisers need to be aware of? (Yes or No) Are you currently taking any medication(s) that the event organisers should be aware of? Emergency Contact Relationship Mobile: SPORTS REGISTRATION DETAILS World Archery 24 Target Field (Marked) Longbow Barebow Recurve ARCHERY Age Group (please circle) Compound Crossbow Target Recurve Registration Closes: Thursday 22 March 2018 Cost Per Person is $20 $ ATHLETICS Age Group (please circle) m 5000m Walk 100m Shot Put 200m Javelin 400m Discus 800m Weight Throw 1500m High Jump 1500m Walk Long Jump 3000m Triple Jump 3000m Walk 10km Road Run & Walk 5000m Registration Closes: 5pm Friday 13 April 2018 Cost Per Person is $30 $ 3

4 BASKETBALL Age Group (please circle) Mixed Only TEAM NAME TEAM ORGANISER Registration Closes: Friday 6 April 2018 Cost Per Person is $50 $ Driven Dressage CARRIAGE DRIVING Age Group (please circle) Gender (please circle) Obstathon $30 per person One Activity membership if not member of the ACDS - only available for Dressage Competition. Cannot be used for Obstathon Competition (must be full ACDS Member). Registration Closes: Tuesday 20 March 2018 Cost Per Person is $50 $ CLAY TARGET SHOOTING Mixed $ Age Group (please circle) Gender (please circle) 25 Target Skeet 25 Target Single Barrel 25 Target Double Barrel 25 Target Point Score Registration Closes: On the day of event Cost Per Person is $50 $ CRICKET Age Group (please circle) 35+ Mixed Gender (please circle) Male TEAM NAME TEAM ORGANISER 7 a side 12/12 match round robin or alternative draw Registration Closes: Cost Per Person is $20 $ Single Association Croquet Double Association Croquet CROQUET Age Group (please circle) 30+ Gender (please circle) Single Golf Croquet Double Golf Croquet Registration Closes: Tuesday 10 April 2018 Cost Per Person is $20 $ Mixed 4

5 Saturday AM Criterium CYCLING Age Group (please circle) Sunday AM Road Race Saturday PM Time Trial Registration Closes: Friday 13 April 2018 $20 per race or $50 for all three $ NOTE Competitors are required to have current Cycling Australia Membership. A weekend license (or day $ pass) is available for non-members for $30 at race registration desk prior to event commencement. DARTS Age Group (please circle) Singles Fours Doubles Registration Closes: On the day of event No Sports Levy TEAM NAME DRAGON BOAT Age Group (please circle) Future Masters: 27-39yrs Corporate/Social: 27yrs+ Senior A (Masters): 40yrs+ Senior B (Grand Masters): 50yrs+ Senior C (Great Grand Dragons): 60yrs+ Breast Cancer Survivor: 27yrs+ TEAM ORGANISER 10 s Breast Cancer Survivor 10 s 20 s Breast Cancer Survivor 20 s Registration Closes: Saturday 7April 2018 $25 per person for first event, $10 per person for each additional event. $ FUTSAL Age Group (please circle) Futsal Registration Closes: Friday 30 March 2018 Cost Per Person is $50 $ 5

6 Thursday 18 Hole Stableford Friday 18 Hole Stableford GOLF Age Group (please circle) Thursday, Friday & Saturday Sunday: Combined Age Saturday 18 Hole Stableford Sunday 18 Hole 2 person ambrose Registration Closes: Thursday 5 April 2018 $30 per person per day $ Thursday Mixed 4s Friday Open Pairs LAWN BOWLS Age Group (please circle) 30+ Saturday Open 4s Partner: Registration Closes: Thursday 5 April 2018 Cost Per Person, Per Event is $10 $ Singles LAWN TENNIS Age Group (please circle) Doubles Partner: Registration Closes: Tuesday 10 April 2018 Singles $15 per person Doubles $10 per person $ MASTERS MILE Male Female Mixed Age Group (please circle) Masters Mile Registration Closes: Entries accepted up to 1hr prior to event Cost Per Person is $5 $ MULTISPORTS Age Group (please circle) Short Course Long Course Stage 1 Kayak 5.7km Short Course Kayak 10km Long Course Stage 2 Trail Run 5.7km Short Course Trail Run 10km Long Course Stage 3 Road Ride 20km Short Course Road Ride 40km Long Course Registration Closes: Wednesday 18 April 2018 $30 per individual, $15 per team member $

7 NETBALL Age Group (please circle) Gender (please circle) Female Mixed TEAM NAME TEAM ORGANISER Registration Closes: Thursday 5 April 2018 Cost Per Person is $35 $ SAILABILITY Age Group (please circle) 30+ Gender (please circle) Mixed TEAM NAME TEAM ORGANISER Disabled Registration Closes: Friday 6 April 2018 Cost Per Person is $20 $ SOFTBALL Age Group (please circle) 35+ TEAM NAME TEAM ORGANISER Registration Closes: Saturday 24 March 2018 Cost Per Person is $50 $ SWIMMING Age Group (please circle) F/S or 400IM 4 x 50m Freestyle Relay 50m Backstroke 4 x 50m Medley Relay 100m Breatstroke 200m Freestyle 50m Butterfly 100m Butterfly 200m Breaststroke 200m IM 200m Backstroke 50m Freestyle 200m Butterfly 100m Backstroke 100m Freestyle 50m Breaststroke Registration Closes: Sunday 8 April 2018 Cost Per Person is $30 $ SQUASH Age Group (please circle) Singles Registration Closes: Sunday 15 April 2018 Cost Per Person is $20 $ 7

8 Singles TABLE TENNIS Age Group (please circle) Doubles Combined Age Doubles Partner: Registration Closes: Friday 6 April 2018 Singles: $15 per person per event Doubles: $15 per person per event $ TRAIL RUNNING Age Group (please circle) km 21.1km 10km 42.2km Registration Closes: Wednesday 18 April km: $10 per person 10km: $15 per person 21km: $25 per person 42km: $45 per person $ PAYMENT DETAILS Compulsory Games Registration Fee $44 SPORT LEVY SPORT LEVY Total Sports Levy $ Total Payment Required (including registration fee) $ I confirm that I have read the following Participation Agreement, signed and attached to my registration ( please tick) Card Type (please circle) Visa Mastercard Name on Card: Expiry / Card Number: CCV 8

9 TEAM ENTRY FORM This entry form applies to team sport entries and must be accompanied by the completed games form by the team organiser. Each team must have a team organiser to complete this section. Sport: Event: Age Group: Team Name: Team Organiser: Address Mobile: Phone: TEAM MEMBERS M / F AGE TEAM MEMBERS M / F AGE Team Colours: Name of Umpires: Alternate Colours: Other Officials: Notes: All individual team members are required in person to register at the Games Hub with photo identification to receive their welcome pack and sign the waiver form required to participate in the games. All individual team members are required in person to register at the Games Hub with photo identification to receive their welcome pack and sign the waiver form required to participate in the games. 9

10 MURRAY BRIDGE GREEN 2018 SOUTH AUSTRALIAN MASTERS GAMES (MBGSAMG) IMPORTANT: READ CAREFULLY AS THIS AGREEMENT AFFECTS YOUR LEGAL RIGHTS 1. INDEMNITY AND RELEASE (a) In consideration of the acceptance (at the organiser s discretion) of my Entry Application Form and fee, I acknowledge that I have read and understood the terms of entry and agree to be bound by the terms of entry. (b) I certify that if I am acting as an agent of the competitor who will be participating in the Murray Bridge Green 2018 South Australian Masters Games (MBGSAMG) and in consideration of the Games Organiser accepting the competitors application to participate in the MBGSAMG, I have the authority and do grant an indemnity to the Organiser on behalf of the team and/or on behalf of each individual competitor. 1.1 Except where provided or required by law and as such cannot be excluded, I agree that it is a term of my acceptance of my Entry Application Form and fee (if accepted at the discretion of the organisers) that for myself, my executors, administrators, heirs, next of kin, successors and assigns, hereby to: (a) waive and release all claims that I may have against the Event Committee, Rural City of Murray Bridge, their officers, agents, directors, members, volunteers, employees, sponsors, stakeholders, Sport, other Accredited Participants (including Accredited Participants and Officials) ( the releasees ) involved in the MBGSAMG and its related activities, including any and all claims, demands or proceedings arising out of my participation in or connection with the MBGSAMG and its related activities, together with any costs including legal fees that may be incurred as a result of any such claim whether valid or not; and (b) indemnify and hold harmless the releasees and each of them against such claim however or whatsoever that I or my guests or any one or more of my executors, administrators, heirs, next of kin, successors or assigns may have or assert and against any costs including legal fees with respect to such claims. 2. ACCEPTANCE AND TIMEFRAMES I will abide by the designated deadlines as stipulated in this Entry Application System and accept that should I not do so, my application for entry into the MBGSAMG may not be accepted. I will abide by the Event rules, as varied from time to time and will abide by directions given by Event officials. 3. INJURY PROCEDURES If I sustain an injury or illness whilst participating in the MBGSAMG, I authorise the appointed Medical Staff to perform and administer emergency medical attention as they think necessary. I agree to receive and pay for medical treatments including transport by ambulance, which is considered by the Medical Staff or Organisers to be advisable and which is provided to me at the request or direction of the Medical Staff or Organisers before, during or after the Event. 4. RULES I will at all times participate in the MBGSAMG upon the principle of fair play, sportsmanship and participation. I will abide by the rules and regulations as set down by the MBGSAMG and by the sports body (Sport) organising the event in which I have applied for entry. I will observe all written and verbal instructions given by authorised personnel and/or Sports officials. I agree that failure to comply with the designated rules may result in my disqualification from the Event and that I am responsible for any actions resulting from my failure to observe the rules and regulations. 5. SUSPENSIONS I accept that if I am, or become subject to any suspension or ban imposed by Sport in which I am entering, I will make this information known to the MBGSAMG and Sport. I accept that my application for entry may be cancelled as a result of a suspension. 6. DRUGS POLICY I agree with the MBGSAMG policy of condemning the use of classified substances for the purpose of performance enhancements. The MBGSAMG recognises that some classified substances may be medically prescribed and that the use of these substances may be permitted on the supply of suitable medical evidence. I support the MBGSAMG application of the Australian Sports Anti Doping Authority guidelines on this issue ( 7. AGE POLICY I acknowledge I will have reached the minimum age by the date as stipulated by Sport. Any variation to this condition must be approved in writing by the MBGSAMG and the relevant Sport before I can participate in any event. Furthermore, I accept that I will be required to register in person at the MBGSAMG Registration Centre and provide recognised photographic identification and proof of age at the time of registration. 8. PROMOTIONAL MATERIAL - I consent to the publication and/or use in any form of media whatsoever of my name, image, voice, results, statements or otherwise, without payment or compensation and agree that I will reasonably expect to receive marketing material, such as SMS, and entry forms, from the MBGSAMG Organiser, Rural City of Murray Bridge and sponsors regarding its events. 9. MURRAY BRIDGE GREEN 2018 SOUTH AUSTRALIAN MASTERS GAMES LOGOS I agree that I will not make, encourage or support unauthorised reproductions of the MBGSAMG logo or name in any form without the prior written permission of the MBGSAMG and accept that to do so may be in breach of Copyright and the Trade Practices Act. 10. REFUND POLICY Some Sports may set a minimum and maximum number of participants due to competition and/or venue restrictions. If my entry application is received after the maximum has been reached, or an event in which I have registered is cancelled, I am entitled to a full refund of the Sport fee for that event. Furthermore, if I am unable to secure a place in any other Sport of my choice and do not attend the MBGSAMG, I am entitled to a full refund of fees paid, less a $20 administration fee. I agree that to be eligible for a refund of any nature an application for a refund must be submitted in writing to the Games Director no later than 5.00pm on 11th April I acknowledge that I am not (and no other person is) entitled to a refund or credit of any nature in relation to the entry fee(s) I have paid (for myself or another person), for any reason whatsoever, or in any circumstances, unless and to the extent that the Organiser is required to provide a refund or payment at law. I acknowledge that the Organiser is entitled to deduct administrative, legal, operational and other costs from any amount (if any) I would be entitled to receive by way of refund (if payable at law). 11. GST - All MBGSAMG Games Fees contain GST. 12. BANK FEES AND CHARGES I accept that should the MBGSAMG be charged any fees by their financial institution as a result of a dishonoured payment on a cheque, debit/credit card debit or international payment fees, I will be responsible for any such fees and will be ineligible to participate in the MBGSAMG until such time as those fees are paid. 13. SPORTS AND PERSONAL INJURY INSURANCE (a) I attest and verify that I am physically fit and have sufficiently trained for the MBGSAMG and its related activities and that I have not been advised by a qualified medical practitioner not to participate in the MBGSAMG. I acknowledge that participating in the MBGSAMG may involve a real risk of serious injury or even death from various causes including but not limited to over exertion, dehydration and accidents with other participants. I voluntarily assume all risks associated with my participation in the MBGSAMG or any activity associated with it. (b) I acknowledge and accept that no Sports/ Personal Injury Insurance is included in the Registration Fee or Sports Levies, and that it is my responsibility to seek my own cover. The MBGSAMG recommends that all competitors seek and obtain their own ambulance cover, medical/ sports/personal/injury/personal public liability insurance, personal accident insurance (including for death or permanent incapacity and income protection) and/or insurance specific to individual circumstances in respect of participation in the MBGSAMG and its related activities. 14. PRIVACY LEGLISATION I consent to my details being disclosed to parties necessary in the conduct of the event (including Sports) and medical officials during any treatment required. 15. GENERAL CONDITIONS (a) I hereby acknowledge that I have sole responsibility for my personal possessions and any related sporting equipment during the course of the MBGSAMG. (b) If I am in breach of the terms of entry I agree to recompense the appropriate party for all loss and damage (including legal fees) arising out of such breach, including any damage to the party s reputation. I (insert full name) Of (insert residential address) Understand and agree to the terms of the 2018 Murray Bridge South Australian Masters Games Participation Agreement 10 Signature Date / / 20

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REGISTRATION FORM WAIVER. E-M AIL ADDRESS: Driver License # DATE OF BIRTH: AGE AS OF DEC. 31, 2018: ADULT T-SHIRT SIZE (S - XXXL):

REGISTRATION FORM WAIVER. E-M AIL ADDRESS: Driver License # DATE OF BIRTH: AGE AS OF DEC. 31, 2018: ADULT T-SHIRT SIZE (S - XXXL): REGISTRATION FORM NAME: GENDER: E-M AIL ADDRESS: Driver License # DATE OF BIRTH: AGE AS OF DEC. 31, 2018: ADULT T-SHIRT SIZE (S - XXXL): MAILING ADDRESS: CITY: STATE: ZIP CODE: PRIMARY PHONE: EMERGENCY