6th WINTER WIPEOUT, JUNE 6, 7 and 8 - 2008 REGISTRATION APPLICATION   A SEPARATE FORM IS REQUIRED FOR EACH INDIVIDUAL PLEASE PRINT CLEARLY- When printing this page, please set ALL your margins to 1cm

NAME:_____________________________________________________________________________   ADDRESS:__________________________________________________________________________   CITY_____________________________STATE:_________________P/CODE:____________________   TELEPHONE:____________________EMAIL:____________________________DATE:______________   SIGNATURE REQUIRED__________________________Parent or guardian to sign if under 18 Signature confirms that I have read and agree with waiver at the foot of this page.   Pick up all tickets & registration at Registration desk - receipt only will be mailed.

FRIDAY NIGHT DANCE (includes tea, coffee, & cake)   SATURDAY NIGHT DANCE INCLUDES LIGHT SUPPER   SUNDAY NIGHT DANCE INCLUDES LIGHT SUPPER   SATURDAY DAY PASS (Does not include dance at night)   SUNDAY DAY PASS (Does not include dance at night)   ALL INCLUSIVE TOTAL WEEKEND PASS

$15.00                    $____________   $15.00                    $____________   $15.00                    $____________   $20.00                    $____________   $20.00                    $____________   $70.00                    $____________

CHILDREN UNDER 16 - Half listed prices and half discounted concessions Children under 5 will be admitted free provided they are accompanied and supervised by an adult.

Early Bird Discount on WEEKEND PASSES ONLY purchased before May 1st 2008   COMPETITION FEES - To compete all fees must be paid in full Entry $5.00 PER COMPETITOR PER DIVISION - applies to all ages           Competitors must also complete competition registration form

$5.00     $________    $________

TOTAL

Please make any cheques payable to: Roxanne Kumre. 4 Jasen St Capalaba, QLD 4157 NO Refunds after May 1,  2008   PLEASE NOTE THAT BECAUSE THIS VENUE HOLDS A LIMITED NUMBER OF PEOPLE, I AM EXPECTING THAT TICKETS TO THE EVENT MAY SELL OUT, SO IF YOU PLAN TO ATTEND, PLEASE REGISTER EARLY TO AVOID DISAPPOINTMENT.   WAIVER I/We agree to hold the organisers of The Winter Wipeout and their agents, families and agents, harmless from suits, claims and demands of every kind and character arising out of and in conjunction with this event. We hereby assign all rights of the photography, video taping and sound recording of us on June 6, 7 and 8th 2008 to The Winter Wipeout and hereby authorise the reproduction, sale, copyright, exhibition, broadcast and distribution of such records without limitation.