| 2005 | Registration Form - Special Events |
Dog Leg Outfitters
Replacing bad luck with nifty gadgets and forms |
| Event | Event name
_____________________________________________________________________ | Date(s) of event
_________________ |
| Participants | Entrant name(s)
_____________________________________________ | Sex (M or F)
___________ | Year of birth
_____________ | USOF member #
_________________ |
Club
________ | E-card number
____________ | Class
__________________ | Eligible for championship? (circle one) Y N |
Address (Street, city, state/provence, zip/postal code, country)
__________________________________________________________ | Phone
____________________________ |
Registration
fee (base) | Check one box. |  Child (0-7 years) | $0 |
| Junior (8-17 years) | $25 |
| Junior team | $25+$5 each extra junior |
| Junior squad-of-8 | $200 |
| Junior with adult | $55 |
| Juniors with adult | $60 |
| Adult | $50 |
| Adult team | $50+$5 each extra adult |
| Adult squad-of-8 | $400 |
| Write the associated fee in box 1. | 1 |
| Exemptions |
Check all that apply. |
Member of US orienteering team
USOF member
Contributing membership in local club
Member of local club
Bringing new orienteer to event
Bringing one or more juniors to event
Dragging spouse or significant other to event
Housing a mapper
Making an orienteering map
Carrying whistle on course
Carrying first aid kit on course
Carrying stretcher on course
Customer of Dog Leg Outfitters in last 30 days
First time orienteer
|
| The total number of credits is _____. Multiply this number by $5 and write the product in box 2. | 2 |
Special
conditions
Attach Sch.A
here. |
Check all that apply. |
Blind
Directionally challenged
Suffering from foot-in-mouth or other contagious disease
|
| If any items are checked, attach Schedule A, Letters From Physician. |
| Additions |
Is there a cash prize for this event? If yes, write $10 in box 3. | 3 |
| Is there an unpaid fee for use of the facilities or for parking? If so, write the fee in box 4. | 4 |
| Do late registration penalties apply? If so, write the penalty in box 5. | 5 |
| Care to contribute to the US Team? If so, write the amount in box 6. | 6 |
| Have you ever failed to check in after completing a course? If so, write $100 for your search deposit in box 7. | 7 |
| Are you renting an E-card? If so, write $30 for your deposit in box 8a and $2 for rent in box 8b. | 8a
8b |
| Are you renting a compass? If so, write $15 for your deposit in box 9a and $1 for rent in box 9b. | 9a
9b |
| Do you need any training maps? If so, add $3 to box 10 and indicate desired map________. | 10 |
| Need an event T-shirt? If so, indicate the size ______, quantity ______, and multiply number times $15 (box 11). | 11 |
| Need childcare? If so, indicate number of children ______ and multiply that number by $10 (box 12). | 12 |
| Need pet care? If so, indicate number of pets _______ and multiply that number by $5 (box 13). | 13 |
| Need full-spectrum glasses to clearly see controls in forest? If so, indicate number __ and multiply by cost (box 14). | 14 |
| Need a dinner? If so, indicate number of tickets ______ and multiply by $15 (box 15). | 15 |
| Total the amounts for lines 3 through 15 and write in box 16. | 16 |
| Payments | Write the Base Registration fee (box 1) in box 17. | 17 |
| Write the Exemptions amount (box 4) in box 18. | 18 |
| Subract box 18 from box 17 and write the difference in box 19. | 19 |
| Write the sum for Additions (box 16) in box 20. | 20 |
| Add box 20 to box 19 and write the sum in box 21. | 21 |
| Does the local club owe you any money for unpaid expenses? If so, enter the amount in box 22. | 22 |
| Subtract box 22 from box 21 and write the difference in box 23. | 23 |
| If the amount in box 23 is less than $0, write the amount to be refunded to you in box 24. | Refund 24 |
| If the amount in box 23 is greater than $0, write the amount to be paid in box 25. | Payment 25 |
| Are you depositing any money (any amounts in boxes 7, 8a, or 9a)? If so, sum those boxes and write the number in box 26. If we think you've been good, you are entitled to this money when you complete your course. | Deposit 26 |
| Sign here | WAIVER: I know I can get hurt or even die while orienteering. If that happens, that's my problem. I also promise to check in when done with the course. |
Your signature
_____________________________________________________________________ | Date
_________________ |
Guardian signature if you are a junior or child
_____________________________________________________________________ | Date
_________________ |