Mr. Surf’s presents 14th Annual Zap Gulf Coast Pro/Am Spring Skim Jam

Date: April 21 & 22
Location: SHARKY’s Beach Club Restaurant & Tki Bar
15201 Front Beach Road Panama City Beach Florida
 
Total= $40 Amateur Division $90 Pro Division 
add$50 for Semi-Pro
 
Cost: $25 for Amateur Divisions
 $75 for Pro Division
($15 separate SKIM USA membership fee (must be active 2012 Skim USA member)
 
DEADLINE- April 18th -NO LATE ENTRIES & NO BEACH ENTRIES
 
Make Check Payable to:SKIM U.S.A. NGFL District
Send Entry to: 7220 Thomas Drive, Panama City Bch FL 32408
 

T-shirt size: xs(BoysL)     S      M     L     XL      XXL  (please circle your size)
 
Note competing in both Amateur & Semi Pro is allowed & encouraged ENTER AGE Division based on age you"ll be 8/27/12
 
Please fill out completely and legibly
____ Minis (8 & under) ____ Men (18-21) _____ Women (15-77) _____Sr Grandmasters (40 & up)
____Menehunes (9-11) ____ Sr Mens (22-24) _____ Girls (1-14)
____Boys (12-14) ____ Masters (25-29) New Division SEMI PRO ______
____Juniors (15-17) ____ Grandmasters (30-39) _____Professional
Sponsors______________________________________________________________________________________
Name:__________________________________________Home Phone:___________________ Work Phone:___________________
Street:_________________________________________________City:____________________State_________Zip________
Age:_________________________Date of Birth:___________________Email:___________________________________________

Hold Harmless Release: This release bars your rights to recover damages in the case of an accident injuring you. READ BEFORE SIGNING! In applying to the Skim USA tournaments, I promise to inspect the contest site, and assure myself that the area is safe for skimming and further agree that I will not skim in the contest unless I am satisfied that the area ands conditions are safe for skimming purposes. In exchange for Skim USA accepting my entry form, I voluntarily agree to assume all risks incident to the sport of skimming. With full knowledge, comprehension, and understanding of these responsibilities, I voluntarily accept and assume all risks involved in the spirit of competitive skimboarding. I will further read and comply with all Skim USA rules and regulations, and do agree that, noting existing weather conditions related to use of the contest site by myself and others I give Skim USA permission to arrange to telecast, show, or print and publish any/or all audio and /or pictures taken of me (movie, video, or still) in conjunction with said event. In consideration of your acceptance of my entry, I intend to be legally bound, hereby for myself, my heirs, executors and administrators, hold harmless and release and forever discharge Skim USA, the city/town of Panama City Beach, the county of Bay, the State of Florida, and sponsors Panhandle Surf Inc. (Mr. Surf’’s Shop), Sharky’s, Towne of Seahaven, and Glaspro Inc., their members, agents, and any officials connected with this competition, from all liabilities for injuries and damages whatsoever, arising from my presence and/or participation in the above described event and do hereby grant the sponsors such releases as described herein. I acknowledge that I have read and understand all of the above.
Contestant’’s signature___________________________________________Date___/___/___

FOR CONTESTANTS UNDER 18 YEARS OF AGE: I HEREBY CERTIFY that I am the parent or guardian of the participant named above, and do hereby give my permission without reservation and with full understanding and comprehension of the aforegoing agreement to hold the aforementioned organizations and government entities harmless of any and all liabilities including any such injuries which are alleged to have occurred as a result of negligent failure of Skim USA Officials, Judges, and Directors to properly supervise contestants in the course of competition.
Signature of Parent/Guardian___________________________________Date___/___/___
 
EVENT INFORMATION:
Mr. Surf’s Surf Shop 7220 Thomas Drive - (850)235-2702 or website: mrsurfs.com
Visit our face Book & "LIKE US" to receive regular updates on Skim Life in Panama City Beach
 
Reservations at Contest Site: (on the beach)
Origin Condos (very nice) 888-908-0006/850-636-8550
Seahaven Hotel/America's best value Inn (standard hotel) 800-874-7101/850-2346636
Please mention the "I'm Back" discountin order to receive %15 off your stay
Contact: Renee Reyer (reneereyer@seahavenbeach.com)  Office:850-588-8667 ext. 2