22nd Annual International Moose
Steel-Tip Darts Tournament
April 22-24, 2016
Hosted by Charles Town, WV 948
2016
Early Bird Event: Thursday, April 21st
Check Here if Attending
Deadlines for entries is March 25, 2016! No on-site entries will be accepted (except for blind draw events).
Each participant must fill out an individual entry form.
NAME MID/WID #
ADDRESS
CITY STATE/PROVINCE ZIP
PHONE NUMBER E-MAIL
LODGE/CHAPTER NAME LODGE/CHAPTER #
DOUBLES
MIXED TRIPS
1)
2)
1)
2)
3)
SINGLES
4-PERSON TEAM
(Check box if participating.)
4-PERSON TEAM
1)
2)
3)
4)
*There is an entry fee of $8.00 per event per player, as well as a $2.00 sanction fee to be included with each entry.
*Prize money for all events will be based on number of entries received.
YOUTH PARTICIPANTS
16 to 20-year-olds (herein referred to as Youth Participants) may participate in the tournament, provided they are an immediate family member of an
individual holding active membership in the Loyal Order of Moose or Women of the Moose. The Youth Participant’s parent/guardian must sign a consent
form and waiver. Youth participants may not receive cash prizes and must be accompanied at all times by parent/guardian.
Youth Participant’s Name Date of Birth
I have read the statement regarding Youth Participants and agree to the terms presented.
Parent/Guardian Signature
Parent/Guardian’s Name (Print) MID/WID #
All entrants must hold active membership in their Lodge/Chapter (except Youth Participants) and present a valid membership card or paid dues receipt at
tournament check-in, as well as a valid photo ID. Mail entry forms and fees to: 2016 International Moose Darts Tournament, Moose International, 155 S.
International Drive, Mooseheart, IL 60539-1173 (U.S. funds only). Entries must be postmarked by March 25, 2016. Questions? Contact Camille Ruffino at
Moose International (630) 966.2213.
On-Site Contact During Tournament: Glenn Greenstreet (304) 283-2608.
22nd Annual International Moose Steel-Tip Darts
Tournament Payment Form
Loyal Order of Moose Members
Women of the Moose Members
Name
Name
CHECK HERE FOR
YOUTH PARTICIPANT
MID
EVENT DAY FEE
MIXED TRIPS (601)
SAT $8.00
MEN’S DOUBLES
(501/CRICKET/501) SAT
$8.00
MEN’S SINGLES (501) SAT
CHECK HERE FOR
YOUTH PARTICIPANT
WID
CHECK (a) IF
ENTERING
EVENT DAY FEE
MIXED TRIPS (601)
SAT $8.00
WOMEN’S DOUBLES
(501/CRICKET/501) SAT
$8.00
$8.00
WOMEN’S
SINGLES (501) SAT
$8.00
4-PERSON TEAM (701) SUN $8.00
4-PERSON TEAM (701) SUN $8.00
SANCTION FEE $2.00 SANCTION FEE $2.00 a
TOTAL
CHECK (a) IF
ENTERING
a
TOTAL
Payment Information Card Type (please circle)
Visa
Master Card
Discover
American Express
Name as it appears on Card: oooo oooo oooo oooo Amount $
Expiration Date: oo/oo
CVV Code: ooo
American Express CVV2 Code: oooo
Credit Card Number:
Signature:
*Check, money order or credit card information must accompany all entries and must be postmarked by March 25, 2016.
*Returned checks must be replaced with and alternate payment (no checks) within 10 days or entry will be cancelled.
*All check and money orders should be made payable to Moose International and money orders must be earmarked 2016 Darts Tournament.
For Office Use Only (US Funds Only)
Date Received by Finance
Name No. $
/
Name No. $
Received by
Name No. $
Name No. $
Notes
/
Date Received by Activities
/
Received by
/
2016
22nd Annual International Moose
Steel-Tip Darts Tournament
Schedule of Events
Thursday, April 21st
Blind Draw* (501, Cricket, Cork Calls) 7:00 PM
*Blind draw event is $8.00 per person payable onsite. Event registration ends at 5:00 PM.
You must be present to sign up. NO EXCEPTIONS!
Friday, April 22nd
Tournament Check-in
2:00 PM – 6:00 PM
Opening Ceremonies
6:30 PM
Blind Draw* (501, Cricket, Cork Calls)
7:00 PM
*Blind draw event is $8.00 per person payable onsite. Event registration ends at 5:00 PM.
You must be present to sign up. NO EXCEPTIONS!
Saturday, April 23rd
Tournament Check-in
8:00 AM – 9:00 AM
Tournament begins
9:30 AM
Events will be thrown in the following order:
Mixed Trips
601
Women’s Doubles
501, Cricket, 501, Men’s Doubles
501, Cricket, 501, Women’s Singles
501
Men’s Singles
501
Single Elimination
Single Elimination
Single Elimination
Single Elimination
Single Elimination
Sunday, April 24th
Tournament resumes
4-Person Team Event
Double Elimination
9:30 AM
701
Charles Town, WV 948 will have breakfast available on Friday, Saturday and Sunday mornings, as
well as nightly dinner specials.
There will be entertainment in the Social Quarters on Thursday, Friday and Saturday evenings.
2016 International Darts Tournament t-shirts will be available for purchase on-site.
Info for International Darts Tournament Lodging
Quality Hotel Conference Center
4328 William A. Wilson Freeway
Harpers Ferry, WV 25425
(304)535-6302 9.0 miles
$99.00 per night*: We are providing
a shuttle from this location
Hampton Inn & Suites
157 Pimlico Drive
Charles Town, WV 25414
(304)725-2200 4.5 miles
$129 Thur. /$169 Fri. & Sat.*
(shuttle not provided)
Turf Motel
(May change to Roadway Inn prior to April)
741 E. Washington St.
Charles Town, WV 25414
(304)725-2081 2.3 miles
$100 per night*(shuttle not provided)
Quality Suites
1937 Short Road
Kearneysville, WV 25430
(304)263-8888 9.3 miles
74.99 per night* We are providing
a shuttle from this location
*Mention Moose International Darts Tournament for discount rates.
Nearby Attractions
River Riders Whitewater Rafting & Zip Lines
Harpers Ferry National Historic Park
Charles Town Races at Hollywood Casino
Bloomery Plantation Distillery
Historic Shepherdstown, WV
All can be easily found by searching the web.