CHIPPEWA VALLEY FAMILY YMCA
 2006 FALL RACQUETBALL SINGLES TOURNAMENT
              REGISTRATION FORM

DATE:  Saturday, 11/11/06                                     TIME:  Starting at 10 am




NAME:_______________________________________________

ADDRESS:_______________________________CITY_______________ZIP_______

PHONE (H)_______________________(W)______________________________

EMAIL ADDRESS:___________________________________

DIVISION               A               B              C               (CIRCLE ONE)
(Circle One)

COST:  SINGLES TOURNEY:  $5.00 YMCA Members (give form and $5 to Brian Rieper
or leave at YMCA front desk ­ Attn: Brian Rieper)

**  Note:  Any nonmembers will have to pay an additional $9 daily admittance fee to use
the YMCA facilities.

Awards:  There will be a prizes for class champions and possibly a few other awards for some
other "fun" activities.
Registration:  Complete registration form and give to Brian Rieper (along with $5 fee) or
register and pay at front desk (YMCA).  Forms will be available at the counter.  THE
DEADLINE FOR REGISTRATION IS WEDNESDAY, 11/8/06 (although walkins will be
welcome).

It is hereby understood by I, the undersigned, participant in the abovementioned activity, am
playing at my own risk; that if I am injured during the tournament, I am financially responsible
for my own injuries.  I hereby waive all claims for injuries, disablements, or cost of it against the
Chippewa Valley Family YMCA.  The tournament director reserves the right to reclassify
players and combine divisions.

SIGNATURE___________________________________DATE_____________
*NOTE:  REGISTRATION FORMS WILL NOT BE ACCEPTED WITHOUT PAYMENT.
THANK YOU!!!
If you have questions please contact Brian Rieper at brieper@sgi.com  or 7264436.