ASA Shootout Tournament
  June 21 - June 24, 2018

 
Mail to: 4515 5th Avenue South
Birmingham, AL 35222
(205) 595-3052

Application and Release Statement

Name _________________________________ Telephone ________

Address _________________________________________________

City ____________________________ State ____ Zip ________

Team Affiliation __________________ Date of Birth _________

Email Address_____________________________________________

SCUBA APPLICANTS MUST PROVIDE THE FOLLOWING INFORMATION

Certifying Agency and Number ______________ Years Experience _____
Registration is $70.00 (ASA Member #________) $80.00 (Non-ASA Members) 


_____  Paid Via PayPal

Total amount enclosed:  $ _______ Make checks payable to: Ala. Spearfishing Assn.
Please enclose this form and mail with "non refundable" payment to the address at
the top of this page.  Mailed registration must be received no later than the Safety Meeting.

RELEASE STATEMENT

I, ________________________, in consideration of permission granted me to
participate in this Spearfishing Tournament to be held June 21-24, 2018,
do hereby agree that I will not hold any official connected with said tournament
responsible for any accident or damage to me or my
property which may occur during
said tournament. I have read, fully understand and agree to the rules of this contest.

Done this _____ day of _________________ 2018.

Signed ________________________  Witness _______________________

________________________________________________
Signature of parent or guardian if under 21 years of age.