February 22, 2003

Print and complete this form.

9:00 am — Open Sabre

11:00 am — Open Epee

12:00 pm — Novice Foil

2:30 pm — Open Foil

(Registration Closes 15min before each event starts.)

General information:

Name:

____________________________________

Address:

____________________________________

____________________________________

____________________________________

Email:

____________________________________

Club affiliation:

____________________________________

Division:

____________________________________

USFA Membership#:

____________________________________

New member? Make check out to USFA for $40, and complete the USFA Membership Application form provided on location.

USFA Rank/year:

Foil: ____________, Epee: ____________, Saber: ____________

Events and fees:

Events:

Fees:

First weapon $15, each additional weapon $5. Fencers may enter open and novice foil for $15. Fencers ranked "C" and above fence that weapon free.

Please make checks out to University of Mississippi Fencing Club.

Waivers and Signatures:

This form must be signed to complete registration.

I hereby waive and release all rights and claims for damages I may have against the University of Mississippi Fencing Club, the University of Mississippi, the officials, managers, sponsors, and other participants from any and all liabilities arising from illness, losses, injuries or damages I may suffer as a result of my participation in this October 27, 2001 fencing tournament. I attest and verify that I am physically fit and have sufficiently trained for this competition. I further waive all rights to any photographs, videotapes, recordings or any other recording of this event for any purpose.

Signature (if under 18, parent or guardian):

__________________________________________________________ Date ____________

Consent for Medical Treatment: (must be signed to complete registration) I understand and appreciate that participation in the sport of fencing carries a risk to me of serious injury, including permanent paralysis or death. I give my consent to representatives of the University of Mississippi Fencing Club to obtain medical care from physicians, clinics or hospitals for any illness that could arise during the October 27, 2001 fencing tournament.

Name of Person to contact in an emergency:

______________________________________________________ Phone _____________