One form per participant
Event Name: La Crosse Log Rolling Open
Event Date: July 12, 2014
ACKNOWLEDGMENT OF RISK,
WAIVER AND RELEASE OF CLAIMS
IMPORTANT NOTICE!!
BEFORE SIGNING THIS AGREEMENT, READ THIS ENTIRE DOCUMENT VERY CAREFULLY. IF AN ACCIDENT WERE
TO OCCUR INVOLVING YOU AND/OR YOUR MINOR/WARD, YOU AND/OR YOUR MINOR/WARD (BY SIGNING THIS
AGREEMENT) WOULD BE GIVING UP LEGAL RIGHTS THAT YOU AND/OR YOUR MINOR/WARD MIGHT OTHERWISE
HAVE. IF YOU DO NOT UNDERSTAND ANYTHING IN THIS DOCUMENT, OR IF YOU OBJECT TO ANY PROVISION
CONTAINED IN THIS DOCUMENT, YOU SHOULD NOT SIGN THIS AGREEMENT AS IT IS DRAFTED AND SHOULD
SEEK ADVICE FROM YOUR LEGAL COUNSEL. REQUESTS FOR MODIFICATIONS TO THIS AGREEMENT MAY BE
DIRECTED TO THE PRESIDENT OF THE UNITED STATES LOG ROLLING ASSOCIATION, INC.
I recognize and acknowledge that there are risks of serious physical and other injuries to participants and/or spectators associated with log rolling and boom running and in demonstrations of log rolling and boom running, including permanent disability
and death, and severe social and economic loss which might result not only from a participant’s or spectator’s own actions but
also from the actions, inactions or negligence of others, the rules of play, or the condition of the premises or equipment used
and, nevertheless, I agree to assume the full risk of any injury, damage, or loss regardless of severity that I, my minor child/
ward, or other family member or kin may sustain as a participant in, or spectator of, any and all activities connected with or
associated with the log rolling and boom running or log rolling and boom running demonstrations conducted at the La Crosse
Log Rolling Open.
I agree to waive, relinquish, discharge, release, and covenant not to sue the United States Log Rolling Association, Inc., the
International Log Rolling Association, Inc. or any of either entity’s members, officers, directors, agents, employees, athletes,
and volunteers from any and all claims of injury, damage, or loss that I, my minor child/ward, or other family member or kin
may have or that may accrue to me or my minor child/ward arising out of, connected with, or in any way associated with the
activities of the La Crosse Log Rolling Open.
I have considered that if this agreement were not as broad as it is, the cost for my and/or my minor’s/ward’s involvement as a
participant or spectator at the La Crosse Log Rolling Open would be considerably higher, and as I do not wish to pay a considerably higher cost, I waive the right to bargain for different terms in this agreement.
Please plan to
attend the
14th annual
L a C ro s s e
Log Rolling
Open
Saturday
July 12, 2014
I have read this agreement thoroughly and fully understand it and enter into it on behalf of myself, my heirs, next of kin, assigns, and personal representatives. No one has made to me representations, statements, or inducements that change or
modify anything written in this agreement.
____________________________________________________________
PRINT NAME OF PARTICIPANT
Signature of participant (or parent/guardian if participant is under 18)
________________________________________________________Date________________
PRINT NAME of person signing if not participant
I want to VOLUNTEER! Please sign me________________________up
for the following:
Judging Bracket/Timer Announcing
Food
Set-up
Clean-up/Tear down
Memorial Pool
1901 Campbell Road
La Crosse, Wisconsin
Tournament sponsored by
the La Crosse Area Log Rolling Association (LALRA)
ORDER OF EVENTS:
Main Inside Heading
AMATEUR EVENTS
10:30 Warm-ups
11:00 Start
 U13 & Adult Sport
 U10 & U17
 U7
30-Minute Elite warm-up
ELITE-LEVEL EVENTS
1:30 Check-in deadline
 Elite Men & Women Log
Rolling
Registration
“received” deadPrice List
line is Thursday, July 10th. $10
late fee applies after Thursday.
List your product or service here
Include description if necessary.
La Crosse Open
Registration
$0.00
One registration form per
competitor. No registrations will be accepted after
9AM
List your product or service
hereon July 12th.
Name______________________________________________________
Address____________________________________________________
List your product or service here
Include description if necessary.
List your product or service here
$0.00
Everyone is encouraged to
bring a water bottle—we will
have ice water dispensers onsite. A complimentary lunch will
be provided. Also, there are
restaurants within walking distance of the pool. Bring your
lawn chair and enjoy the day!
Contact Donna Burns if you
have any questions.
[email protected]
608.769.8654
$0.00
description if necessary.
Email_____________________________Include
Phone___________________
Birth Date________/_______/________ Gender _________________
List your product or service here
Include description if necessary.
List your product or service here
EVENT SELECTION
Include description if necessary.
Junior Division, 17 & Under (Age as of 1/1/2014)
List your product or service here
U10 (8-10) Log Roll
Include description if necessary.
$0.00
$0.00
Adult Division
7 & Under Coed Log Roll
We LOVE our
volunteers!
Volunteer
opportunities
available on
reverse side of
registration
panel.
$0.00
Include description if necessary.
Adult Sport Log Roll
List your product or service here
Adult Elite Log
Include description if necessary.
$0.00
$0.00
Roll
U13 (11-13) Log Roll
U 17 (14-17) Log Roll
List your product or service here
Include description if necessary.
All log rolling competitions will take place on carpeted logs.
$0.00
USLRA MEMBERSHIP (Required to compete in tournament)
I am already a 2014 US Log Rolling Association (USLRA) Member
(Memberships available at USLogRolling.com)
List your
product
or service$5
herefor a
$0.00
I am
enclosing
day membership for this tournament
Include description if necessary.
ENTRY FEE
$25 Juniors & Adult Sport ($60 Maximum per family excluding per roller late fees.
List your
product or
service
Family
maximum
does
not here
apply to$0.00
Elite Rollers.)
Include description if necessary.
$30 Elite Log Rolling
Bu sin e ss Nam e
Amount Enclosed for this Competitor:
Primary Business Address
List your product or service here
Send
registration and
Include description if necessary.
payment to:
$0.00
La Crosse Open
c/o Donna Burns
2421 Hoeschler Drive
La Crosse WI 54601-6867
Entry Fee(s) Your Address Line 2
Caption describing
__________
picture
or graphic.
Your Address Line 4
USLRA Membership
_________
Your Address Line 3
TOTAL
Phone: 555-555-5555
(checks
payable to LALRA)
Fax: 555-555-5555
E-mail: [email protected]
___________
Call Donna if you have questions 608.769.8654