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2011SE_EntryForm

2011SE_EntryForm

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Published by ryan5295
2011 SE Regionals Entry Form
2011 SE Regionals Entry Form

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Published by: ryan5295 on Feb 25, 2011
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2011 SE v006 BA & TMc -- 2011-02-24  Page
1
of
6
 
          
Presents the
2011 SOUTHEAST REGIONALSURFING CHAMPIONSHIPS® 
 
Scheduled Dates:  April 16-18, 2011Anastasia State Park, St Augustine, FL
 
Qualifier to the 2011 THE EASTERNS® 
 
Contest Headquarters:  Mention ESA for discount
The Hilton Garden Inn401 A1A Beach Blvd.St. Augustine, FL 320801-800-762-5311
 
Information:
Contest Director Burgess Autrey, Southeast Region Director
 
Eligibility:
Certified district representatives who are members in good standing of theESA through SEPTEMBER 30, 2011.  A contestant applying for entry whosemembership expires before September 30, 2011 must renew his or her membershipwith entry fee.  Entry will be rejected and the slot passed on if this procedure is notfollowed.  Entry is open only to those competitors who are in full compliance with theESA Competition Code (rev. Jan 1, 2006.)
 
Entry Instructions:
Please complete the attached entry form and forward with checkfor entry fee
to your LOCAL DISTRICT DIRECTOR IMMEDIATELY.
Addresses oflocal District Directors are on listed later on this application.
 
NOTE:  If your membership expires before September 30, 2011 please fill out themembership form and attach a
separate
check for a membership renewal form.
 
Alternates:
Please follow same instructions as above.  If you have a slot in onedivision and are an alternate in another division, fill out separate entry forms and attachseparate checks.  Note: A second entry form can be downloaded from the ESAcompetition website at www.surfesa.org/content/section/6/28/ 
 
Entries
not received by your Local District Director on/or before
Friday, March 07,2011
will not be accepted or you will be considered as a late paid alternate.
 
From: Mary Ann Mangiacapre 
 
ESA’s Competition Director:
 
Competitors are responsible for using the proper equipment and abiding by the ESARules of Competition.  Competitors are responsible for schedule changes, as the posted schedule is always subject to change due to weather conditions.  There will be 
no refunds to “no shows” in a posted heat.  Competitors are expected to conduct 
themselves in a sportsmanlike manner at all times.
  
 
2011 SE v006 BA & TMc -- 2011-02-24  Page
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EASTERN SURFING ASSOCIATION 2011 SOUTHEAST REGIONAL SURFING CHAMPIONSHIPS® 
 
 
AGE DIVISIONS FOR THIS EVENT (age as of January 1, 2011)
 
Menehunes (11 & under)  Girls (14 & under)   Menehune Longboard(Boys/Girls 14 & under)  Junior Women (15-17)     (Boys/Girls 14 & under)Boys (12-14)    Women (18-29)    Junior Longboard (15-17)Junior Men (15-17)   Ladies (30+)    Mens Longboard (18-34)Men (18-24)         Masters Longboard (35-49)Masters (25-34)    Menehune Bodyboard   Legends Longboard (50+)Senior Men (35-44)     (Boys/Girls 14 & under)  Womens Longboard (29 & under)Grandmasters (45-54)   Open Bodyboard   Ladies Longboard (30+)Legends (55-64)     (M/F all ages)Grand Legends (65+)Open Shortboard(M/F all ages)
 
Entries must be received by your Local District Director on/or before Friday, March 07, 2011:
 
Local District Directors addresses:
                            
ESA-NGFL District
 Vince RileyPO Box 513Shalimar, FL  32579
ESA-TCFL District
Cheryl & Charles Williams1571 3rd AvenueVero Beach, FL  32960
ESA-CFL District
Rob Henry & Tom Evans385 Hibiscus BlvdMerritt Island, FL  32952
ESA-WFL District
Greg Agerskovc/o The Surf Shack Surf Shop5210 Gulf Blvd.St. Pete Beach, FL  33706
ESA-FCFL District
Rick Chapman & Steve Sugarc/o Pipeline Surf Shop2022 1st Ave.Fernandina Beach FL  32034
ESA-NFL District
c/o Co-Dir Kathy Austin12361 Burgess Hill Dr.Jacksonville, FL  32246
ESA-SAFL District
Will Gresham103 Alicante RdSaint Augustine, FL  32086
ESA-PBFL District
c/o Co-Dir Shellie Chiet1511 Seabrook RoadJupiter, FL 33469
ESA-AL District
Chuck Barnes14178 River Rd. Unit CPerdido Key, FL  32507
     
 
ESA-NCFL District
Gene Verano & Ryan MarksPO Box 1551New Smyrna Beach, FL  32170
ESA-SFL District
c/o Dutch Schorn1701 North Federal HwyFort Lauderdale FL  33305
 
 
2011 SE v006 BA & TMc -- 2011-02-24  Page
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EASTERN SURFING ASSOCIATION 2011 SOUTHEAST REGION SURFING CHAMPIONSHIPS® 
Check-in Saturday, April 16 -18, 2011 - 7:30 am SHARP!
 
 
SEE NEXT PAGES FOR MANDATORY SIGNATURES!
 
Contest Headquarters
(Ask for ESA discount):The Hilton Garden Inn, 401 A1A Beach Blvd., St. Augustine, FL 32080, 1-800-762-5311,
 
Contest Information:
Burgess Autrey, SE Region Director, email: southeastesa@aol.com or http://www.surfesa.org/  
 
Host District Directors:
Will Gresham ESA SAFL Director
 
 
Time/Heat Information:
Posted on-line at: http://www.SurfESA.org/ 
 
Entry Fees:
 
$95.00 First Event / $60.00 Each Additional Event
 
 
INVITED COMPETITORS & ALTERNATES:  DO NOT
combine entry fees and membership fees in one check (attachseparate checks to each form).  All mailed checks will be deposited to allow time for checking clearing.  CHQ will issueany refund due to a non-slotted competitor within 30 days from Friday, March 04, 2011.
 
 
Two part OFFICIAL ENTRY FormESA 2011 SERSC
Entry Deadline:  Midnight, Friday, March 07, 2011It must also include a signed hold harmless form that is on the next page
A contestant applying for entry whose membership expires before September 30, 2011 must renew membership.
 
ESA District:  __________________________ 
Member’s
current expiration date is:  ____________________________ 
  
Name:  __________________________________________________________________________________________ 
  
Age: (as of 1/1/2011) _______________________ Date of Birth (mm-dd-yyyy): _________________________________ 
  
Mailing Address:  _____________________________________________ City:  ________________________________ 
  
State:  __________________ Zip:  ___________________ Telephone (Home):  ________________________________ 
  
E-mail Address:  ___________________________________________________________________________________ 
  
Emergency Contact-Name and Phone Number:  __________________________________________________________ 
  
Any known allergies to medications or other pertinent health issue: ___________________________________________ 
  
_________________________________________________________________________________________________________________________ 
 
  
Name of 1st Event ($95):  ___________________________ Name of 2nd Event ($60):  ___________________________ 
  
Name of 3rd Event ($60):  ___________________________ Name of 4th Event ($60):  ___________________________ 
  
T-Shirt Size:  Adult sizes only, please circle your size:  (Sm) - (Med) - (Lg) - (XLg)  or  (XXLg)
  
First Entry Fee ($95)                                  $________________________ 
  
Additional Entry Fees ($60 each Divs.)               $________________________ 
  
Total fees enclosed (make payable to ESA) $________________________ 

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